Registration Form

REGISTRATION

Name_______________________________________________________________

Parish/School/Office ____________________________________________________

Address ______________________________________________________________

City__________________________________ State __________Zip______________

Phone_________________________ Fax___________________________________

E-mail Address ________________________________________________________

Breakout Registration

Please indicate your preference for each workshop session. Indicate your choice by letter (A – F).

Session 1 _____ Session 2 _____ Session 3 _____ Session 4 _____

Eucharistic Ministers

We are looking for volunteers to serve as Eucharistic Ministers for the closing session.

Can you help in this way? ____________ Yes!

Morning Yoga:

We must know in advance if you are planning on attending. Yoga will be held at 7:00 a.m. each morning. The location will be announced in the conference programs.

_____ Monday ______ Tuesday ______ Wednesday

Fees: Registration postmarked by February 1, 2004

Full conference $150 $____________

Full conference $140

(2 or more registering from the $ ___________

same parish– registrations must

be sent in together. Make a copy

of this form for each staff member)

One Day Rate _____days @ $60 per day $ ___________

After February 2, 2004

Full Conference $165 $ ____________

I wish to make a donation to the conference scholarship fund $ ____________

Total Enclosed $ ____________

Make checks payable to HEARTLAND CONFERENCE

Mail check and registration form to:

2004 Heartland Conference

Box 7097 • Kansas City, MO 64113-0097

Cancellations and Refunds: Cancellations made prior to Feb. 1, 2004 are subject to a $25

cancellation fee. No refunds will be issued after Feb. 1.

Financial assistance is available. Application forms are available on the Conference website

or e-mail Mary Mueller at mueller@diocesekcsj.org.

Conference Registration includes:

Two concerts, two lunches, refreshment breaks, Yoga, daily Mass, five outstanding keynote speakers and your choice of 24 breakout sessions.

New this year... two lunches and preconference concert are included in the conference registration.

FOR MORE INFORMATION

Contact the Conference Office 816-361-1703

heartlandconference@GBRonline.com

Or visit our website,