191st ANNUAL COUNCIL — DIOCESE OF MISSISSIPPI — SOUTHAVEN January 26-28, 2018

CHURCH GROUP REGISTRATION Church: _________________________________________________City ___________________________________________

Please enclose check(s) totaling $145.00 per person, OR $95.00 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: 191st Annual Council Mail to: St. Timothy's Episcopal Church, 8245 Getwell Rd., Southaven, MS 38672

Delegate

After December 8, regisration is $155.00 / $105.00 per person After January 1, registration is $165.00 / $115.00 per person REFUND OF $40 UNTIL JANUARY 8. NO REFUNDS AFTER JANUARY 8.

Young Adult (non-delegate)

o Mission

College Representative

Parish

Spouse of Ret.Clergy/Seminarian

o

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