n4

For the Lord has chosen Jerusalem

Registration

Adults:
Registration before October 1$20.00
Registration after October 1$30.00


Couples registration before October 1$30.00
Couples registration after October 1$40.00

Children & Youth:
Children ages 5-17 (1-3 children - each)$5.00
Children ages 5-17 (4 or more children max. charge)$20.00
Children ages 0-4no charge
Total Enclosed (in U.S. dollars only please)$_______

Names of all attendees (and children’s age):

Name:   Age: 

Name:   Age: 

Name:   Age: 

Name:   Age: 

Name:   Age: 

Name:   Age: 

Name:   Age: 

Name: 

Address: 

City:  State:  Zip: 

Email address: 



Register Early
and Save!



Make checks payable to:

Church of the Messiah

Fill out, print this form and mail with payment to:

Sukkot2011
1180 Upper Bellbrook Rd.
Xenia, Ohio 45385

or Submit online and mail in your payment (this will open your mail client to send the registration).