186th ANNUAL COUNCIL — DIOCESE OF MISSISSIPPI — JACKSON February 1-3, 2013

CHURCH GROUP REGISTRATION Church: _________________________________________________City ___________________________________________

Please enclose check(s) totaling $105 per person, OR $55 per seminarian, seminarian spouse, college representative, young adult (non-delegate under 35 years old) or retired clergy spouse. NOTE: If clergy spouse is attending, they must be registered

Email: Email: Email: Email: Email: Email: Email: Email: Email: Email: Email: Email: Email: Email:

Seminarian

Visitor

ADDRESS EMAIL (if no email, please enter "none"

First Name (As desired for Name Tag)

Alternate

Last Name

Clergy

Make check payable to: 186th Annual Council Mail to: St. Andrew's Episcopal Cathedral, P.O. Box 1366, Jackson, MS 39215-1366

Delegate

After November 1, regisration is $115 / $65 per person After January 1, registration is $125 / $75 per person CANCELLATIONS MUST BE MADE BEFORE JANUARY 14 TO RECEIVE $40 REFUND.

Young Adult (non-delegate)

 Mission

College Representative

Parish

Spouse of Ret.Clergy/Seminarian

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