ST. RAPHAEL MINISTRIES, INC.
P.0. B0X 160, Half Moon Bay, CA 94Ol9
E-Mail: srm.inc@juno.com
INFORMATION OR REGISTRATION:
800-456-4197 . FAX 650-726-5394
REGISTRATION FORM
Please list each name as you wish them printed on name tags.
List all additional persons registering on form;
NAME ______________________________________________ (Please specify , "Y" for High School and "C"for Child)
ADDRESS___________________________________________ 1_________________________________________________
CITY _______________________STATE__________________ 2_________________________________________________
ZIP_________________PHONE________________________
E-Mail_____________________________________________
CONFERENCE REGISTRATION FEES
ONLY:
(your canceled check will be your receipt)Cash_____ Check_____Credit
Card_____Date____________
Adult:
$60 until 2/28
$75 until 6/15 $85
at the Door------------------------$__________
Married Couple: $105 until 2/28
$120 until 6/15 $130 at the
Door----------------------$__________
Youth & Children: $20 until
2/28 $25 until 6/15
$30 at the Door-----------------------$__________
Family (2 adults, 2 children
under 18 Free) $125 until 2/28 $140 until
6/15 $180 at the door$__________
One Day: Friday $35 ( ) , Saturday $ 49 (
) Sunday $35 ( ) until 6/15 -
$55 Per day at the door-$__________
SPECIAL DISCOUNTED PACKAGE CROWNE
PLAZA HOTEL OF FOSTER CITY
CONFERENCE REGISTRATION FEES
PLUS HOTEL 3 DAYS / 2 NIGHTS
Adult: (double occupancy): $165
PER PERSON until 2/28 $175 until 6/15
Later $195 -$__________
Adult (Single occupancy):
$265 until 2/28
$275 until 6/15
Later $285 -$__________
Married Couple:
$295 until 2/28
395 until 6/15
Later $315--$__________
Family:
$310 until 2/28
$315 until 6/15
Later $325 --$__________
Donation to help others attend------------------------------------------------------------------------------------------$__________
Total Paid (Make checks payable to Saint Raphael
Ministries)---------------------------$__________
I will pray one Rosary or other prayer daily for the
success of the Conference ----------------- ( )
CHARGE: VISA MC DISCOVER AMEX Card No._____________________________________
Exp. Date______________________Signature _______________________________________
You can FAX credit card registration to (650) 726-5394
or E-Mail: srm.inc@juno.com
For more information call 1(800)456-4197