Franciscan Renewal Center - Scottsdale, Arizona
April 24-27, 2012


Training Event Registration Form

* Be sure to print a completed copy of this form for your records before submission.*

 

First Name
Last Name
Email Address
Phone Number (Format: 999-999-9999)
Preferred name for nametag
Diocese
In what order of ministry do you serve?
What is the status of your diocesan Fresh Start Program? (check all that apply)
What is your anticipated role with Fresh Start in your diocese?
What is the name and email address of your Diocesan Fresh Start coordinator/contact person?
Preferred Mailing Address:
Address:
Phone (Work/Day)
Phone (Cell)
Phone (Fax)
I have the following dietary restrictions, allergies, special needs:
Have you attended a Fresh Start training event in the past? If yes, where and when?
If you have served as a facilitator or coordinator in the past, list when and where:
If you have been a participant in a diocesan program, list when and where:
If you are clergy, what is your ordination date?
Please answer the simple math question below to submit the form.
2 + 2 =

Registration Payment

$1,200.00 per registrant

To submit your registration and pay online using Google Checkout, click the "Google Checkout" button above.
To submit your registration without paying online, click in the box next to "Checkout" above and then click "Submit."

***Once you submit your registration and make your travel arrangements, please go back to the "Event Details and Registration" page and complete the "Travel Information Form."***

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