SSE : Summer School 2005 - Application Form

Application Form for Summer School 2005

Mr Mrs Miss Married Couple

Name:

Spouse:

Address

Postcode:

Phone (w)

(h)

(m)

Date of Birth

email address

Are you a member of Disciples of Jesus Community? Yes No

If not, Christian affiliation (eg. parish, other community, prayer group)

If first Summer School, name and position of referee

Have you ever attended a Life in the Spirit Seminar? Yes No

Special needs (dietary, accommodation):

Do you have a medical condition we should know about?

Note:

All applicants must attach a note with a short answer to the following question: "Why do you want to attend the SSE and what are your expectations?"

Yes, I have enclosed a separate sheet with the answer to the above question

Yes, I am a first time participant and have enclosed a reference

Yes, I have ordered a T shirt/s and have enclosed the order slip with payment

	Adult
	Student ( <18)
	Concession
	Couple
	Children < 12 yrs	x

I enclose my cheque/money order for

$ deposit OR $ full payment

I agree to fully participate in the Summer School and comply with the School requirements as indicated by the organisers. I hereby release Disciples of Jesus Community from any liability regarding my attendance at the 2005 Summer School.

Signature

(Signature of parent if <18)

Children's Names & Ages

NUMBERS ARE STRICTLY LIMITED. GET IN EARLY!