MIND GAMES
Conference
Registration Forum

 

To register for this conference:

  1. Print out this page
  2. Fill out the information below
  3. Enclose a check made out to "CPCI, Inc." for your total registration due.   Price is only $28 per person.
  4. Mail your registration form to:   CPCI, Inc.
                                                         2020 Cato Avenue
                                                         State College, PA 16801

Please print.

Name: ____________________________________________   [  ]  male   [  ] female

Home address:________________________________________                                 
               City:________________________________ State: ___  Zip:_____________
Phone (home): (     )                               Home Church:________________________

I'm attending this conference as a (please check all which apply):

[  ] High school student    [  ] College student     [  ] Grad student    [  ] Parent
[  ] Freshman   [  ] Sophomore   [  ]  Junior    [  ] Senior   [  ]Youth worker/adult
[  ] Pastor/Youth Minister    [  ] Other: _______________________________

Amount Paid:  _____ (pre-registered at $28 each)     _____ (at the door:  $35 each)