Professional Documents
Culture Documents
REGISTRATION FORM
JUNE 14-17, 2018 MEMPHIS
Name: _____________________________________________________________________________
Address: ___________________________________________________________________________
City: ________________________ State: _________ Zip: ________ Phone: _____________________
Cell Phone: __________________ Email:________________________________________________
ACTIVITIES
THURSDAY FRIDAY
Welcome Ceremony at Double Tree Hotel Picnic
SATURDAY SUNDAY
Morning Options: National Civil Rights Museum, Coleman Chapel CME Church Service
Casinos, Golf, Shopping
Evening: Banquet
Accomplishments
List family and individual accomplishments (awards, degrees, recognition, etc.).
1. ________________________________________________________________________________
2. ________________________________________________________________________________
3. ________________________________________________________________________________
Registration T-shirt Sizes
Fees cover ALL activities, t-shirt, scholarship Extra t-shirts WILL NOT be ordered. Please
donation, and breakfast Friday, Saturday, and make sure you put the correct size on this order
Sunday. form.
Adult: S, M, L, XL, 2XL, 3XL
Youth: YXS (2-4), YS (6-8), YM (10-12), YL (14-
16)
Payment Information
Quantity
Adult Registration _____@ $135.00 = $ ______ Make check payable to:
John Simpson
Youth Reg.(5-12) _____@ $110.00 = $ ______
Family of 4 (-$20) _____@ $470.00 = $ ______ Mail completed form and check to:
Under 5 ______@ Free John Simpson
9260 Bluebird Hill Cove
Lakeland, TN 38002
Adult T-shirt
Size: _______ ______Free w/Reg. Email: jsimpson622@gmail.com
Youth T-shirt
Size: _______ ______Free w/Reg.
Total $___________
Amount Enclosed $___________
Balance Due $___________
Balance may be paid in four (4) payments.
Total due before April 30, 2018.