2011 Charismatic Rally Registration Form

* Registration for:

One Adult ($15.00)

Two Adults ($30.00)

One Teen ($10.00)

One Family ($40.00)

* Last Name:

* First Name:

* Email:

* Telephone:

* Parish:

* Age:

If registering as a Family:

Spouse First Name:

Spouse Age:

Children

	Child 1	Child 2	Child 3
First Name
Age

	Child 4	Child 5	Child 6
First Name
Age

* Indicates Response Required