--------------------------------------March 16-18, 2012----------------------------------------

　

1. 个人资料 Personal Information:
　

Contact Title

中文姓名

Last Name

First Name

性别
Gender

年令
Age

Status

 所属校园或教会
Church/Campus Fellowship

语言
Language

 

2. 通讯资料 Correspondence Information:

住址 Address  

城市 City                     州State                        邮递区号 Zip code

电话 Tel. (daytime):           (evening): 

传真 Fax:                电子邮箱 E-mail:

 

　

　

　

　

3. 费用 Fees: 注册费含手册及膳食包括2晚住宿/用餐/节目 Registration fee including 2 nights lodging, meals and program.

项目

Items

2月1日以后报名
 After2/1

Sub-Total

注册费Registration Fee:
　

$125 per person (4 people in a room)

$

$175 per person (2 people in a room)

$

自由奉献 Free will offering

  $   

共计 Grand Total

$

　

4. 报名缴费方式 Payment methods：

    信用卡 Pay by Credit Card

    支 票 Pay by check:

请将支票及填妥的报名表，寄回基督使者协会总部，或当场缴费：
Please mail your check along with the registration form to AFC or pay on site:

Vision Home 2012, c/o China Outreach Ministries

555 Gettysburg Pike, Suite A-200

Mechanicsburg, PA 17055

（支票抬头Make check payable to VisionHome2012）

　

5. 请选择你海归後最可能落脚的地点 Select the location which best describes where you will likely reside after returning to China.

   

　

6. 退修会报名连络人 Contact Person

     祝峥嵘 Zhu ZhengRong (John), VisionHomeChina@gmail.com, (978) 656-1196