1. Student Registration Form Deadline – May 24th July 16-20, 2017
Name: _________________________________________________________________
Address: ____________________________ City/State/Zip: ____________________
Phone: _________________ DOB: _____________________
____________________________________ Church _______________________
Parental Consent:
Name: ____________________________ Relationship: ________________________
Phone: __________________________ Signature: ____________________________
Please indicate Lodging Choice
□ Hotel (Must include adult supervison)
I will be sharing a room with:
_________________ _________________
_______________________________________
□ Cedaridge Dorms
Cost Information
Does not include transportation
Includes 4 nights lodging and meals
Per person
Cedaridge Ministries Dorm: $130
Hotel: $475 single / $275 double
$210 triple / $175 quad
Hampton Inn or Cumberland Inn
Williamsburg, Kentucky
Area in which you wish to work:
_____ VBS _____ Construction _____ Creative Arts (Music, Puppets, Skits)
Any Specialized Area? __________________
Other info: ______________________________________________________________
For more information, contact:
Ron Lynch:
MBA office