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Registration Form

“Are You Hearing Voices?”: A Discernment Retreat

Thursday, June 28^th through Saturday, June 30^th, 2012

Fee: $175 (includes lodging and meals)

Please fill out one form per registrant. If you have any questions, please contact the director of Lifelong Learning, Michelle Carlson, at mcarlson@ltsg.edu .


Name:
Street:
City:
State:
Zip:
Email:
Home Phone:
Cell Phone:
Work Phone:

Home Congregation:
ELCA Synod:
If you are not a member of the ELCA, which denomination are you?:

Emergency Contact Information

Name:
Relationship:
Phone:
Email:

Seminary Lodging & Meal Reservations

Do you require special needs for lodging?:

YesNo

If yes, please let us know how we can best serve your needs:

Would you be willing to share a room if needed?:

YesNo

Please list any medical or dietary restrictions/concerns or other special requests that will help us in planning for your stay:

How did you hear about this retreat?:

After completing this form, please put a check for your deposit of $50 made payable to the Lutheran Theological Seminary at Gettysburg in the mail to:

Michelle Carlson

Director of Lifelong Learning, LTSG

61 Seminary Ridge

Gettysburg, PA 17325