NAME (Last)_____________________________First______________________M.I._____
STREET ADDRESS________________________________________________________
CITY_____________________________________ STATE_________ZIP_____________
Office Phone______-______-_________ Home Phone______-______-________
Cell Phone _____-_____-________ E-mail____________________________________
I / we are driving __ flying __ by airline ____________ flight #_____ into airport __________
Time of arrival ____________ Need shuttle to conference? ____ Yes ____ No
Cost is $225.00/registrant ($200 for spouse) - each room is a single room
MAKE CHECKS TO: APC or Academy of Parish Clergy
SEND REGISTRATION TO REV. JIM DEITZ NO LATER THAN APRIL 10th
109 Hickory Hollow Court, Amherst, OH 44001
For more information/questions: contact Dr. David Imhoff, dielpadre@aol.com.
Office phone is 904-744-5333