190th ANNUAL COUNCIL — DIOCESE OF MISSISSIPPI — JACKSON February 3-5, 2017

CHURCH GROUP REGISTRATION Church: _________________________________________________City ___________________________________________

Please enclose check(s) totaling $140.00 per person, OR $90.00 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: 190th Annual Council Mail to: St. Columb's Episcopal Church, 550 Sunnybrook Rd., Ridgeland, MS 39157

Delegate

After November 15, regisration is $150.00 / $100.00 per person After January 1, registration is $160.00 / $110.00 per person REFUND OF $40 UNTIL JANUARY 14. NO REFUNDS AFTER JANUARY 14.

Young Adult (non-delegate)

 Mission

College Representative

Parish

Spouse of Ret.Clergy/Seminarian

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