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*** Please Print And Mail This Form ***

30th Annual Catholic Charismatic Conference
Diocese of Pensacola-Tallahassee
March 4-6, 2011

Please list ALL who will be attending.

Your Name ___________________________________ Spouse __________________________

List Children (first and last name, if different, and only those who will be attending the conference)

_____________________________________________________________________________

Address ______________________________________________________________________

City/State/Zip __________________________________________________________________

Number of Children (age 1 and up) for which you would like free child care ______

Telephone ___________________ E-mail Address ____________________________________

ONSITE REGISTRATION WILL BE $30 per person or $50 per family.

Clergy, Religious, Students andUnder 18 can attend at no cost.

Pre-Registration Conference cost: $25 for an individual $45 per family


Registration Fee: $__________

            *Donation: $__________

                    Total: $__________


Payment Method:   __ Check enclosed payable to DCCR   __ VISA   __ MC

Card Number: _____________________________   Expiration: _________________

Secure Code: ___________   Signature: _______________________________________


*Making a donation helps to defray registration fees for those unable to afford those fees.



Conference Registration, P.O Box 37342, Pensacola FL 32526.


FOR THE BEST ROOM RATES AND ROOM SELECTION PLEASE MAKE YOUR ROOM RESERVATIONS WITH THE HILTON SANDESTIN BEACH RESORT BY FEBRUARY 11, 2011.
Telephone: 1-800-559-1805
(Mention "Catholic Charismatic Conference.")