| Please print out this registration form and send it in with your payment so that we can prepare your tickets. Saturday activities are free to all who wish to attend. |
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# of People |
Total Cost |
| Friday Night Banquet Attendees $25 per Person |
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| Saturday Boxed Lunch $5 per Person |
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| Graduation Attendee's |
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No Cost |
| Total Cost.. |
________ |
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Name: ______________________________ Spouse: ________________________ |
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Street: ___________________ City: __________________ St: _____ Zip: ________ |
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Phone: _________________________ Email: _______________________________ |
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| Indentify Yourself |
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Inste Student |
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Inste Leader |
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Other __________________ |
| Spouse |
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Inste Student |
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Inste Leader |
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Other __________________ |
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| Church:_____________________________________________________________ |
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| Method of Pament |
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Check |
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Mastercard |
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Visa |
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| Card Number |
_______ _______ _______ _______ |
Exp Date |
______/______ |
| CVS |
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(The last three numbers on the back of the credit card |
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| Billing Address
(where you receive your C.C. bill) |
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Same as above |
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| Street:___________________ City:__________________ St:_____ Zip:_________ |
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Signature: ________________________________________ |
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Print Name: _______________________________________ |
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| If you are registering more than 1 married couple, use multiple forms and then staple the forms together and send to the Inste Office. |
