Name _____________________________________________________________

Address __________________________________________________________

City ___________________________   State ___   Zip _______________

Phone ____________________________    Male ______    Female ______

E-mail address ___________________________________________________

$_______ Your registration ($60 per person)

$_______ Spouse registration ($30) and Name ______________________

$_______ One-day registration ($20 per person)

$_______ Double-occupancy room ($51 per person, 3 nights) 

         Name of Roommate ____________________

$_______ Single-occupancy room ($81, 3 nights)

$_______ Food package ($65 per person, 8 meals)

$_______ Saturday lunch at Camp Mack ($6)

$_______ Total amount due

Please make check payable to Grace College and mail it with 
this registration form to:

		Brethren World Assembly
		Attention Bill Darr
		Grace College and Seminary
		200 Seminary Drive
		Winona Lake, IN 46590