The Magical Mystery of Marriage

Full Names:

Names also used for name tags.

Address:

City, State, Zip:

Phone:

Wedding Date:

Email:

Years Married:

Check one of these:

Enter 1^st & 2^nd choices

1st

2nd

Saturday Program Attendance

Preferences:

Mini-Retreat  __   OR

  Workshops ___

Session 1 (A, B, or C):

Make choices:

Session 2 (D, E, or F):

Session 3  (G):

G

Saturday Dinner

Will Attend:  ____  (Y or N)

Attendees, please make one choice per person: 

Chicken:

Fish:

Vegetarian:

Special Needs:

Sunday Breakfast

Will Attend:  ___  (Y or N)     Indicate number:

Are you first time conference attendees?  (Y or N):

Check if you receive the  Florida ACME newsletter:

Check if you receive the National ACME newsletter:

Amount Enclosed.  (See rates below.)

Make check payable to Florida ACME

Conference Cost:

       $159 if postmarked before 8/1/04

       $179 if postmarked after 8/1/04

This includes Saturday dinner, Sunday breakfast, snacks & refreshments, materials, and use of hotel facilities.

Refund Policy:

 Before 9/1/04: Full refund

After 9/1/04: 50%

Print form, complete it and send with check to Conference Registrars:

David and Mandy Ealy

3315 NE 30^th Court

Ocala, FL  34479

To contact them:

Phone: 352-867-7965

Email: MandyEaly@juno.com