*** Please Print This Form ***

29th Annual Catholic Charismatic Conference
Diocese of Pensacola-Tallahassee
January 8-10, 2010

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 __________________________________________________________________

Telephone ___________________ E-mail Address ____________________________________

(Conference cost: $25 for an individual $45 per family; Clergy, Religious, Students, and Under 18 - no cost)

Don't forget the PROPHECY WORKSHOP!

Registration Fee...: $__________

*Donation............. : $__________

Total Enclosed......: $__________

*Those who make a donation help to defray registration fees for those unable to afford those fees.
Everyone is welcome, regardless of financial ability to contribute.

Please make checks payable to DCCR.

Mail to: Conference Registration, P.O Box 1122, Niceville. FL 32588-1122.

FOR THE BEST ROOM RATES AND ROOM SELECTION PLEASE MAKE YOUR ROOM RESERVATIONS WITH THE EDGEWATER BEACH RESORT BY DECEMBER 9, 2009.
Telephone: 1-800-874-8686
(Mention "Catholic Charismatic Conference.")