188th ANNUAL COUNCIL — DIOCESE OF MISSISSIPPI — JACKSON February 6-8, 2015

CHURCH GROUP REGISTRATION Church: _________________________________________________City ___________________________________________

Please enclose check(s) totaling $115.00 per person, OR $65.00 per seminarian, seminarian spouse, college representative, young adult (non-delegate under 35 years old) or retired clergy spouse. NOTE: If clergy spouse is attending, they must be registered

Email: Email: Email: Email: Email: Email: Email: Email: Email: Email: Email: Email: Email: Email:

Seminarian

Visitor

ADDRESS EMAIL (if no email, please enter "none"

First Name (As desired for Name Tag)

Alternate

Last Name

Clergy

Make check payable to: 188th Annual Council Mail to: St. Philip's Episcopal Church, 5400 Old Canton Rd., Jackson, MS 39211

Delegate

After November 1, regisration is $125.00 / $75.00 per person After January 1, registration is $135.00 / $85.00 per person CANCELLATIONS MUST BE MADE BEFORE JANUARY 14 TO RECEIVE 50% REFUND.

Young Adult (non-delegate)

 Mission

College Representative

Parish

Spouse of Ret.Clergy/Seminarian

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