Registration Form |
| REGISTRATION FORM Family Name____________________________________ First Name______________________________________ Male__________________ Female__________________ Street Address___________________________________ City, State & Zip Code____________________________ University you attend_____________________________ Home phone_____________________________________ Email___________________________________________ Spouse's family name______________________________ Spouse's first name________________________________ ___________My spouse will attend with me. ___________My spouse will not attend with me. Names, ages and sex of children (if attending)________________________________________ ________________________________________________ A non-refundable deposit is needed with this form of: _____ I am not a Christian. _____ I am a Christian. _____ I am involved in Bible study/Church. Name and phone # of group leader who is organizing your retreat trip__________________________________________. _________________________________________________ __ I would prefer motel style housing. I understand I will be charged the higher rate for this if this option is still available. __ I would prefer a standard cabin at the lower rate. A non-refundable deposit is needed with form. $15 per adult, $5 per child (ages 4-11) Registration deadline is May 9, 2003 Make checks payable to: ISI Mail to: Kevin Fannin 15 Kansas City St Rapid City, SD 57701 |
Feel free to contact Kevin Fannin at 605-348-7696, or staff@dakotaisi.org