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Title:

First Name: *

Last Name: *

Email Address: *

Address:

City:

State:

Zip Code:

Phone:

Cell Phone:

Special needs/skills:

Primary language spoken:

I will need an interpreter:

yes

I certify that I am at least 18 years old: *

Yes

Age: *

GROUPS: Number of adults attending (18+) NOT including myself:

Number of youth participating with me (age 12-17):

Number of children participating with me (age 11 and under):

I will need FREE childcare during the event:

yes

I would like a FREE event t-shirt:

yes

I will be attending the Celebration Lunch and Service:

yes

Number of people attending the Celebration (including myself):

I attend one of the sponsoring United Methodist Churches:

yes

Church I attend (if any):

I would like to receive event updates:

Yes

How did you hear about this event: *

I would like to know more about the United Methodist Church:

yes

Volunteer Registration