13th National Encounter
Xavier University, Cincinnati, OH
July 17-20, 2003
Registration Form
Cost for the 13
th National Encounter is $250.00 if paid in full by May 15, 2003(Please use a separate form for each registrant)
(PLEASE TYPE OR PRINT LEGIBLY - THANK YOU ** PLEASE FILL IN ALL THE BLANKS)
Preferred Language: ________________________________________________________________
Last Name: _______________________________
First Name: _______________________________Preferred Complete Name for Name Tag: ________________________________________________
Address: ___________________________________________________________________________
City: ______________________________________ State: __________ Zip Code: ______________
Home Telephone: _____________________Work#: ________________________
Fax#: ______________ E-Mail Address: _____________________ Diocese: ___________________
Age group (Circle one): Under 30 30 – 45 46-60 over 60
Health (Circle one): Excellent Good Fair Poor
Gender (Circle one): Male Female
Spouse attending? Yes_____ No______
If you desire to room with a specific individual (spouse, friend, etc) then the other individual's Registration Form must accompany this form. We will not be able to guarantee any particular roommate if the forms do not accompany one another.
Roommate preference? (Circle One) Yes:___No: ___ If Yes, Name: ___________________________
Special needs (dietary/handicap/walking or problems with steps/etc.): _________________________
Date you attended Cursillo and where: __________________________________________________
Are you currently involved in music ministry? Yes______ No______ Would you like to be part of the
Liturgical Team for the Encounter? Yes_______ No_______ What is your talent?____________Send form and payment to:
National Cursillo Center
P.O. Box 210226
Dallas, TX 75211-0226
Telephone: (214) 339-6321, Fax: (214) 339-6322, e-mail: tomsarg@gte.net
Full payment of $250.00 per person and form must be received by May 15, 2003.
Registration cost will be $300.00 per person from May 16, 2003 – June 15, 2003
Registration cost will be $325.00 per person from June 16, 2003 – July 10, 2003
Registration cost will be $350.00 per person after July 10, 2003