Harvester Christian Church

Apples of Gold Application for Participation Form
2009 Session: Tuesday evenings, January 6 through February 17

Completely fill out the form below to register.

PERSONAL INFORMATION

First Name
Last Name
Address
City
State
Zip
Date of Birth
Anniversary Date
Spouse's Name

Best Time to Reach me is	Day Night
Daytime Phone
Evening Phone
Email Address
Do you have any food allergies?	Yes No
If so, please list.
	CHURCH RELATIONSHIP
Are you a member of Harvester?	Yes No
If not, do you attend another church?	Yes
Where?

How did you hear about this seminar?
	Due to the limited availability of this seminar, we need to know your commitment for attendance. The Apples of Gold Seminar covers six 3-hour sessions over a 6-week period.
I commit to attending all six sessions	Yes No