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Women at the Well 2021 Registration Form
Name
First
Last
Ecclesia
Address
Street Address
City
State / Province / Region
Postal / Zip Code
Dietary Requirements
Phone
Email
Confirm
I am willing to help with [please select at least 2]...
Reading
Praying
Chairing
Singing in a choir
Sharing a thought/testimonial
Leading a prayer group
Playing the piano
Playing another instrument (please provide details in comments)
Sharing another skill (please provide details in comments)
Do you require transport to or from the camp?
Yes
No
Can you provide transport to the camp?
Yes
No
For how many?
First aid certificate or nurse?
Yes
No
Have you organised a room of 4-5 people? (optional)
Yes (please list roommate names in the comments)
No
Room requests and other comments
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