I.C.U.A. of Maryland, Inc.

97thNational Convention–Memphis, Tennessee

July 23 – July 30, 2016

National Pre-Registration Form

(Please Print Clearly –Convention Badges are made from this information)

Name______Unit______

Phone#______Church______

(In case of an emergency, please notify)

Name: ______Relationship: ______

Phone # ______Cell/other: ______

Check only one:

□Past National Officer □National Officer □State President □Delegate □Visitor

Pre-Registration Fees: Senior - $50 Young Adult - $50 Junior - $45

Check Department: □Senior □ Young Adult □Junior

Events & Activities

Tickets / Food Functions held during the National Convention should be paid during Pre-registration submissions. Please adhere to your Unit’s requested deadline(s) to ensure your activities are credited properly and tickets are made available.

Money for Pre-Registration and Activities are due to the State Financial Secretary,

Sandra Sellman – 11306 Duxbury Dr., Upper Marlboro, MD 20774 – 301-350-6106 – ,

throughyour Unit on: May 28, 2016.

Pre-Registrations / Price / # Tkts / Total
Senior & Young Adult / $50.00
Junior / $45.00
Events/Activities
Sunday Night Musical – “Men Of The Gospel” / $10.00
Monday Night Musical / $ 5.00
Let The Good Times Roll (Wednesday) – Outing Only / $50.00
Outing & “Financial Freedom Get-Away / $55.00
“Financial Freedom Get-Away / $15.00
Education Program (Thursday Night) / $5.00
Doorkeeper / $25.00
WJM Training Workshops - Include Worksheet with Registration / $20.00
Young Adult Talent Show – ($10/$20/$30) / $
Junior Evening of Elegance (Tuesday Night) / $20.00
Junior Friday Outing (Permission Slip Required) / $40.00
Food Functions
Past National Officers Prayer Breakfast (Sunday) / $35.00
Unity Luncheon (Tuesday) / $55.00
Closing Banquet (Friday) / $65.00
Totals
FORM AND MONEY DUE TO STATE FINANCIAL SECRETARY BY May 28, 2016
Cynthia Hicks, State President
Louis Parker, Board of Trustees Chairman
Tina Brown, State Treasurer