2015 Conference Annual Gathering
Missouri Mid-SouthConference UCC
“Rebuild, Restore, Renew”
Thursday, June 4 – Saturday, June 6, 2015
Holiday Inn Executive Center - Columbia, MO
This form may be completed on your computer.
Please check ONE box below:
Lay Delegate Certified Christian Educator
Youth DelegateConference/Association Officer
Ordained MinisterYouth Visitor
Licensed/Commissioned MinisterAdult Visitor
FirstLast Name:
(as you want it to appear on your name tag)
Street:
City: State: Zip:
Church/Institution/Agency:
City:
Daytime/Cell Phone: Evening Phone:
Email Address:
Emergency Contact: Emergency Contact Phone:
Relationship to Contact Person:
PLEASE READ THE BELOW INFORMATION!
NEW VENUE: The Holiday Inn Executive Center, 2200 I-70 Dr. SW, Columbia, MO 65203.
Phone: 573-445-8531 Website:
IMPORTANT: Each person attending the 2015 CAG is responsible for making their own hotel reservation at the Holiday Inn. A UCC discounted rate of $99.95 per night, Wednesday through Friday during our event (plus tax), is available. Please use the local phone number above to make your reservation and mention “UCC”. The discounted rate cannot be guaranteed if you call toll-free.
To make your reservation online at the discounted rate please visit: (If you do not use this specific link, the $99.95 room rate will not be guaranteed). Once you click into the link, enter your dates of stay. Notice the block code (CJ5) is already loaded to receive the discounted rate, so do not change or remove.
Click “Check Availability” and continue as instructed. You will receive a confirmation at the end of the process for your records.
REGISTRATION PRICES/OPTIONS:
Base Price: - Includes cost of registration/worship/programming materials, Thursday plated dinner, Friday breakfast buffet/lunch buffet/plated dinner, Saturday breakfast buffet (subsidized by Cornerstone and United Church Funds) and Saturday lunch buffet. Please note that Thursday lunch will be on your own.
$175.00 for Conference delegates, clergy and visitors ($210.00 after May 22nd)
$75.00 for registration as a Youth, 7th - 12th grade ($100.00 after May 22nd)
NOTE: Supervision of youth will be the responsibility of their host church delegates/pastors or their parents.
DAILY OPTIONS: - the following options are for those unable to attend CAG all 3 days. Prices include meals. No further breakdowns/options per day are available. Below please indicate which meals you plan to attend per day.
Thursday Only Price: $50.00
I will be attending dinner I will not be attending dinner
Friday Only Price: $90.00
I will be attending breakfast I will not be attending breakfast
I will be attending lunch I will not be attending lunch
I will be attending dinner I will not be attending dinner
Saturday Only Price: $50.00
I will be attending breakfast I will not be attending breakfast
I will be attending lunch/closing worship I will not be attending lunch/closing worship
OPTION – Children’s Meals (for all 3 days):
$50.00 per child, ages2 -11 for meals. (No cost age 2 and under)
1). Child’s Name: Age:
2). Child’s Name: Age:
OPTION – Child Care: - will be provided at no cost for infants/toddlers/pre-schoolers up to age 4.
1). Child’s Name: Age:
2). Child’s Name: Age:
OPTION – Children’s Programming: - will be provided at no cost for children in kindergarten to 6th grade.
1). Child’s Name: Age:
2). Child’s Name: Age:
Any additional information we need to know about your child(ren), i.e. allergies, special needs, etc. Please be specific:
TOTALamount enclosed or to be charged $
Method of Payment:
Check is enclosed.
I will be payingonline – a completed registration MUST be sent to our Conference office to confirm your attendance. Your form may be faxed to 314-918-2601, emailed to Renee, or snail mailed to our office at483 E. Lockwood Ave, Ste. 15, St. Louis, MO 63119.
To help us make your Conference Annual Gathering experience more enjoyable, please answer the following questions (if applicable):
I am allergic to
I am a vegetarianI am diabetic
Other
IMPORTANT!
Registration deadline is Tuesday, May 26, 2015! – Please be respectful of this date. Meal counts need to be given to the hotel and we ask for your cooperation in registering prior to 5/26/2015.
No refunds after Monday, May 18, 2015.
Payment for the 2015Conference Annual Gathering must be received prior to your attendance in Columbia, MO.
If you are paying by credit card, please use the embeddedlink provided on the previous page or on our Conference website. If you need assistance, please contact the Conference office 314-962-8740.
Please return completed registration formto our Conference office via:
EMAIL: Renee Cordes,
SNAIL MAIL: Missouri Mid-South Conference, 483 E. Lockwood Avenue, Suite 15
St. Louis, MO 63119
FAX: 314-918-2610