NAME

                                                           
Name of congregation (if applicable)

                                                           
Address & Phone of Congregation

□ Lay Volunteer           □ Youth Director

□ Director of Christian Education

□ Clergy                       □ Other          

                                                           
Address

                                                           
City, State, Zip

                                                           
Phone

                                                           
Email Address

Full payment must accompany registration.  Checks should be made payable to:

Lutheran Shared Ministries