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