2012 NEDA Conference

Please provide the following contact information:

First Name
Last Name
Church's Name
Church's Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Phone where you can be reached
E-mail

If your spouse is attending, please enter his/her name in the space provided below.

If your spouse is attending, is s/he a voting church delegate?

Yes No

Are YOU a voting church delegate?

Yes No

Choose one of the following host housing (provided by Grace Community EFC) options:

Need host housing Wed. night only
Need host housing Thurs. night only
Need host housing Wed. and Thurs. nights
Do not need this, I will make other arrangements to stay at the camp,** hotel, etc., on my own

If you have any additional information you would like to relay to the NEDA office, please indicate that here:

How many people are you registering for the conference and meals?

x $90*

How many people are you registering for the conference only (NO meals)?

x $31*

Total amount enclosed = $ *

*Please make checks for registration payable to NEDA.

**Please remember that if you choose Camp Housing an additional cost of $35 for one night and $49 for two nights will be paid by you directly to Camp Spofford at the time of the conference.  Contact Spofford info@campspofford.org to reserve your camp accommodation.  Thank you.

May we suggest that you print out two copies of this form--one that you will send in with your check and one for your own records.  Also, please be sure to hit the submit button at the bottom of this page to send your registration electronically.  Thank you for registering online!

Return this form and check ASAP to:

NEDA

ATTN:  NEDA Conference

PO Box 467

Farmington, CT  06034-0467