May 2009  
*Please fill in all fields; where necessary indicate "NA"   
Together In Faith Collaborative Registration
NAME:
ADDRESS:
CITY:
STATE:
ZIPCODE:
HOME PHONE:
CELL PHONE:
E-MAIL:
AFFILIATION IF ANY:
FAITH DENOMINATION / SPIRITUAL BACKGROUND IF ANY:
ARE YOU CURRENTLY PART OF FAN (FAITH ACTION NETWORK):
YES
NO
SERVICES REQUESTED: Check all applicable
ASL:
WHEELCHAIR ACCESSIBLE:
BRAILLE:
DIETARY (as noted)
OTHER (as noted)
REGISTRATION FEES:
(Includes full program, all lodging and meals)
Sliding Scale $50 - $275 (Please pay according to your means)
INSERT AMOUNT $
HOUSING: Check All That Apply *All participants are
encouraged to stay for the full time of the Collaborative
FRIDAY
SATURDAY
SUNDAY (until 1PM
Check-out between
1-2PM)
CONTRIBUTION/REGISTATION PAYMENT:
I would like to include this gift to support the TIF 2007 Collaborative
and enable the participation of those who could not otherwise attend.
I would like to make this gift in memory of:
I would like to make this gift in honor of:
I wish to make an anonymous contribution.
Do not print my name in the program book.
CHARGE AMOUNT:
VISA
MASTERCARD
DISCOVER
AMEX
NAME ON CARD
CARD NUMBER
EXPIRATION DATE
SECURITY CODE
You will receive a
confirmation e-mail
within 72 hours of your
registration.

Please note:
To participate in ALL
team building activities a
General Release Form
needs to be submitted.
Information will only be
shared with necessary
personnel.

Please click here for form.

The General Release can
be faxed, mailed, e-mailed
or provided at time of
Collaborative.