School of Spirituality 2008 - 2009

Please print

Name

Name on Tag

Email:

Street Address:

City

State

Zip Code

Home Phone	(       )
Work Phone	(       )
Birthday: Month		Day

Occupation

Church/Parish

City of Parish

Applicant's Signature

For Office Use Only
Fee Paid	Cash/Check	Date Received
Acceptance Letter

Fee: $180.00
Mail application with registration check of $25.00 (non-refundable) to:
Episcopal Center For Renewal
10290 Monroe Dr Ste 101
Dallas TX 75229-5718