Registration Form Chaplains

Register for the 2018 Chaplain and Campus Minister Retreat April 25 at Eureka College. Deadline to register is April 20 at midnight.

Your Name

Address

City State Zip Code

Phone


Your Email

College/University

Title

Food intolerances and dietary restrictions

$ _ (PayPal click 'Pay Now' button below)

If paying by check is your only option please email Laurie at
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