Encuentro 2009

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Forma de Registracion / Registration Form

Nombre/Name:______________________________________

                                (Primer/First)                              (Segundo/Middle)                               (Apellido/Surname)

Domicilio/Address:_______________________________________________________________

                                      (Numero de calle/Street number)              (Ciudad/City)             (Estado/State)       (código postal)

Teléfono/Phone Number:  (      ) _____________________   (       ) ______________________

                                                                            (Hogar/home)                                                    (Celular/cell)

E-mail:_____________________________________ Preferencia/Prefrence:   Engish       Español

Iglesia/Church:_____________________________ Pastor/Pastor:__________________________

Bautizado(a):    Si/Yes         No/No                        Espíritu Santo/Holy Ghost:   Si/Yes         No/No

Fecha de Nacimiento/Date of Birth:_______/_______/_______ Edad/Age:__________________

                                                                          (Mes)         (Día)          (Año)

Estado Civil/marital Status:   Soltero/Single       Casado/Married       Viudo/Widow

Firma da Aplicante/Applicants

Signature:______________________________________________  _______/_______/_______

                                                                                                                                                                   (Fecha/date)

***Padre o Guardián/Parent or Guardian:

______________________________________________________  _______/_______/_______

                (Firma/Signiture)                     and                      (Relación/Relationship)                           (Fecha/date)

*** SI APLICANTE ES MENOR DE EDAD (18) NECESITA FIRMA DE PADRE O GUARDIAN

*** IF APPLICANT IS UNDER AGE (18) WE MUST HAVE A PARENT OR GUARDIAN SIGNATURE