Participant's Name --------------------------- E-mail ---------------------------------------

Congregation ------------------------------ City/Town ---------------------------------------

Session a (10:45 - 11:45 am) Workshop # -   Participants are not "locked in"

Session b (1:00 - 2:00 pm) Workshop # -       to these preliminary workshop choices.

Session c (2:15 - 3:15 pm) Workshop # -         They may change at any time.

Childcare requested -yes -no 
Childcare will be available on site in the campus Childcare Center. Children will be with others in their age group and will be provided lunch and age-appropriate activities coupled with a lively and interactive schedule throughout the day. A free-will offering will be graciously accepted.

If yes, please list child(ren)'s name, age, and any allergies, medications, or other pertinent medical conditions -

Fees:
Express check-in will be available for those congregations registered with payment prior to the event.
Registration with payment on or before March 3 is $15.00 per person, includes lunch
Registration after March 3 is $18.00 per person, includes lunch
 

Submit payment (checks payable to Northern Illinois Synod) by March 3, 2006 to:
Nancy Corey-Registrar
Northern Illinois Synod–ELCA
Augustana College
Rock Island IL 61201-2296

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