Southwestern Unitarian Universalist Conference

Louisiana Rally 2008

Name*:

Street Address*:

City*:

State*:

Zip Code*:

Gender*:

Home Phone*:

Mobile Phone:

Email address:

Food preference*:

Allergies or dietary restrictions:

Other special needs:

Mugbook Quote:

T-shirt Size*:

smallmediumlargeXLXXL

Would you like to lead a workshop?:

If yes, please give a brief description and any materials you will need.:

Estimated time of arrival:

Emergency Contact (name and relationship)*:

Emergency Phone Number*:

Congregation Name (indicate if CLF member)*:

Congregation Address:

Congregation City and State*:

Name and number of a church official*:

FOR YOUTH

Birthdate:

Grade:

Advisor(s):

FOR ADULTS

Role:

I will be sponsoring the following youth::

Verification: