2015 Registration Form – NYAC Mission u July 23-25, 2015

Western Connecticut State University-UPDATE: back to West Side Campus, Danbury, CT

Adult (18+):$325with on campus housing (2 bedroom suites for 4 w/ traditional HIGH dorm beds)

$235 commuter (we have a block of rooms at the Ethan Allen Hotel; you must reserve if needed and you must have your own transportation from the hotel to the campus)

Youth (entering grade 9-12):$285with on campus housing (double occupancy w/traditional HIGH beds)

$195 commuter (must have housing and transportation)

Youth (entering grade 5-8):$235 with on campus housing (double occupancy w/traditional HIGH beds)

$145 commuter (must have housing and transportation)

Child (entering grade K-4): $100 first child, $85 for 2ndchild in same family- with on campus housing

$60 first child, $50 for 2nd child in same family –commuter

On campus housing, you must bring your own linen: bedding (regular twin size), blanket, pillow, towels OR

Order a linen packet: $30. Deadline to order is June 12, 2015.

Make check or money order payable to: NYC Mission u

Mail Registration Form and payment to: Gail Ross, 58 Shady Lane, Huntington, NY 11743

*** JULY 1, 2015 *** DEADLINE FOR REGISTRATION AND PAYMENT *** JULY 1, 2015 ***

Please check if Jo Gibson Scholarship applicant, deadline June 5, 2015 (for first-time participants): __ No __ Yes

Name: ______(F) _____ (M) _____

Local Church: ______NYAC District: ______

Home Address

Street: ______Apt # ______

City, State, Zip code: ______

Phone number (home or cell): ______

E-mail address: ______

Emergency Contact

Name: ______Phone # (home/work/cell):______

Special Needs (Dietary, Allergies, Physical, etc.): ______

My roommate is:

Check if you need a roommate:Check if you are a commuter:

Mission u choir (closing worship): _____ No _____ Yes: Soprano Alto Tenor Bass (circle one)

Instrument you play well and would like to bring (for worship): ______

Adults-please choose oneMission Study: 1 = first choice, 2 = second choice. All will be enrolled in the Spiritual Growth Study - Created for Happiness: Understanding Your Life in God (English or Korean).

_____ Geographic: Latin America: People and Faith(check one)____English ____ Korean ____ Spanish

_____Issue: The Church and People with Disabilities (English)

Adults are responsible for purchasing the study book at NYAC (June), Mission u, or the Mission Resource Center.

_____ Youth Study (entering grades 5-12)(youth covenant formrequired) _____ Children’s Study (entering grades K-4)

(parental consent and sponsor covenant (if applicable) formsrequired for youth and children)

Sponsor’s Name (requiredfor youth or child): ______

Registration questions, Gail Ross631-274-8156 (weekdays) 631-754-0312 (night/weekends) or