Uywi09 Reg Form - Fall

HOW TO REGISTER Online: www.uywi.org

877-FAX-UYWI

Fax:

urban youth workers institute 2009

GROUP LEADER - Confirmation of your registration will be sent to this person

(877-329-8994)

Mail:



Urban Youth Workers Institute Attn: Registration 6925 Aragon Circle, Ste 6 Buena Park, CA 90620

Discount Expiration Dates

Register online or postmark by Feb 29 or April 15 to qualify for early rates.

Last Day to Register

Pre-Registration closes Tuesday May 6th. After that, we invite you to register at the door.

Team Rate

Teams of 5 or more from the same church/organization who register together can qualify for the Team rate.

Spouse Rate

As a special incentive for couples in ministry, when you signup together, one of you can attend at the Spouse Rate.

Cancellation/ Transfer Policy

If you are unable to attend, another youth worker can attend in your place. You can cancel your registration up to May 6th for a refund, less the $50 non-refundable deposit. Cancellations after May 6th are non-refundable.

Group Registration The group leader receives all correspondence and is responsible for communication with their group. If members of your group wish to pay individually, we accept multiple checks or credit card payments for your group registration.

Travel

Read detailed travel information, including available discounts, at

www.uywi.org

Location

Azusa Pacific University The Felix Event Center

Church / Organization Name name e-mail mailing address ( ® Church ® home ) City

(

)

daytime phone

( ® home

-

® church / org

® cell)

state male / female

ziP

Preferred roommate

HOUSING ® Thu, 5/14 ® Fri, 5/15 ® Sat, 5/16 ® No Housing

additional attendees - For more attendees, copy this form or download it from www.uywi.org name e-mail mailing address ( ® Church ® home ) City

(

)

daytime phone

( ® home

-

® church / org

® cell)

state male / female

ziP

Preferred roommate

name e-mail mailing address ( ® Church ® home ) City

(

)

daytime phone

( ® home

-

® church / org

® cell)

state male / female

ziP

Preferred roommate

name e-mail mailing address ( ® Church ® home ) City

(

)

daytime phone

( ® home

-

® church / org

® cell)

state male / female

ziP

Preferred roommate

name e-mail mailing address ( ® Church ® home ) City

(

)

daytime phone

( ® home

-

® church / org

Special Instructions or Coupon Codes:

® cell)

state male / female

ziP

Preferred roommate

HOUSING ® Thu, 5/14 ® Fri, 5/15 ® Sat, 5/16 ® No Housing HOUSING ® Thu, 5/14 ® Fri, 5/15 ® Sat, 5/16 ® No Housing HOUSING ® Thu, 5/14 ® Fri, 5/15 ® Sat, 5/16 ® No Housing HOUSING ® Thu, 5/14 ® Fri, 5/15 ® Sat, 5/16 ® No Housing

CALCULATE FEES



By Dec

Fall Rate 15th



# of Persons

$ TOTAL

701 East Foothill Blvd Azusa, CA 91702

Individual



$100





x



$

Team of 5 or more

$85





x



$

Meals

Spouse

$50





x



$

x



$







Options: Pay in Full, or $50/person non-refundable deposit





- $

Balance Due at Check-In







(West Campus)

UYWI provides continental breakfast on Friday and Saturday, plus Saturday lunch and dinner. There is an on-campus café and many nearby restaurants for meals on your own.

Housing

Dorm-Style housing is available on the APU campus on Thu, Fri & Sat nights. Register early to ensure housing availability. Dorm rooms have two twin beds, and linens and towels are provided.

Call with any questions

1-800-REG-UYWI (800-734-8994)



Dorm Housing

$25 x # of nights _______

Total Fees: Registration Plus Housing



Amount Enclosed





$

=

$

Method of Payment ® Check payable to UYWI….. Amount on check

$

® Credit Card ® Visa ® MC ® Discover ® AmEx

$

Amount of Charge

Cardholder’s Name













Card Number









Exp Date 3-Digit Security Code







/

Card’s Billing Address





Zip Code



Signature