2012 Eastern Carolina Cluster Gathering

1. Eastern Carolina Cluster Gathering - March 17, 2012

Register below for the SED Eastern Carolina Cluster Gathering. "Technology in Congregations," on March 17th, hosted by the UU Congregation of Greenville, NC.

Registration form must be submitted no later than March 10 if you are requesting CHILDCARE!

Please go to www.uugreenvillenc.org/cluster for additional information, such as updates, schedules, etc.

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* 1. Please register each adult or youth separately:

First name

Last name

Email address

Phone

Postal address

City, State, ZIP

Congregation

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* 2. Any dietary concerns that we ought to be aware of?

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* 3. I have these mobility-related requests:

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* 4. Please list the names and ages of children who need CHILDCARE:

child one:

child two:

child three:

A signed consent form, available at the check-in desk when you arrive, is required for all children under 18 years of age.

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* 5. I request Home Hospitality:

for Friday night

for Saturday night

If possible, I would like to stay with:

Registration fee is $20 for each person 13+, and $5 for those under 13.

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* 6. My payment:

will be sent to the SED office at 9704 Mallard Creek Rd., Charlotte, NC 28262

will be made online

Other (please specify)

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* 1. Please register each adult or youth separately:

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* 2. Any dietary concerns that we ought to be aware of?

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* 3. I have these mobility-related requests:

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* 4. Please list the names and ages of children who need CHILDCARE:

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* 5. I request Home Hospitality:

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* 6. My payment:

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* 7. (For office use only) Payment received: