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2017 ELCA Campus Ministry Staff Conference Registration Form
Email address
First Name
Last Name
Cell Phone Number
Work Address (street)
Work Address (City)
Work Address (state)
Work Address (zip code)
University/College/Area You Are Serving
Title
ELCA REGION
Your Organization
Emergency Contact Information (Name)
Emergency Contact Information (Relationship)
Emergency Contact's CELL PHONE
Conference housing will be in Dobie Twenty21, a private dorm on the University of Texas campus. Every conference participant will have a private sleeping room. Some sleeping rooms will be connected suite-style with a shared bathroom and living room. If you have a preference for the person assigned to the other half of your suite, indicate their name in the 3rd slot marked other:
What nights will you require housing at the University of Texas? Early arrival for Tuesday night is available for a $45 additional charge except for members of the LuMin Board and Conference Planning Team who will be meeting that day.
Please state if you have dietary needs/preferences.
Required
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