Onederful Life Registration Form

Registration Form

ONEderful Life Singles Conference – 2009 Where Singles Connect with God and Their Single Life…

August 14-16, 2009

UPA Family Life & Worship Center Pastor Tracy S. Noel 8449 N. Fox Hollow Road · Bloomington, IN 47408 · Phone (812) 876-2896 www.upafamilylife.org

Fees: $25 in Advance (Before August 2, 2009) $35 Late Registration or At-The-Door Registration Includes Syllabus, Reserved Seating, Fun/Food/Fellowship Friday & Saturday following Evening Service, Saturday Morning Sessions Please Make Checks Payable To: UPA Family Life & Worship Center Mail Registration w/ Payment to:

Susan Taylor · 7195 S. Shields Ridge Road · Bloomington, IN 47401 Contact Susan or Steve Taylor (812) 824-4610 or (812) 322-4985 or Email: [email protected]

Name: ____________________________________________________________ Email: _______________________________________________________________________

Street Address: _____________________________________________________ City: _____________________________________________________________ State: ________

Zip: _____________

Gender: Female ___ Male ___

Home Phone: (_____) ______ - ____________ Cell: (_____) ______ - __________

Age Category: (Please Circle One)

21-30 31-40 41-50 51-60 70+Years Old