WESTERN OHIO MISSION CENTER

Registration Form
Leaders Retreat
October 16-18, 2009

Name:______________________________________

Name:______________________________________

Address:____________________________________

City:_______________________________________

State:________________  Zip:__________________

Phone:_______________  Email:_________________

Special Needs:________________________________

Mission Center (circle one):    BMC    EGLMC   WOMC

Registration:

$25.00 x _______poeple = $__________

Banquet:

$15.00 x _______people = $__________

Print and fill out this form. Mail it with your check, payable to EGLMC, to:

     EGLMC Office
     9017 Chillicothe Road
     Kirtland, OH 44094-9261

Registrar: Sandy
440-256-1441, toll free 866-256-7537
eglmcsandy@roadrunner.com