BUILDING CHRISTIAN COMMUNITY
ABN 55 081 496 175
APPLICATION FOR PARTICIPATION IN PREPARATION FOR KAIROS
South Coast NSW Residential Program on 22 May 2015 – 24 May 2015
Venue:
The Pines
Craddock Road Tuross
(Note: The following information will be kept confidential)
PLEASE PRINT CLEARLY
TITLE & FULL NAME (as shown on driver’s licence): …………………………………………………………
Preferred Name (for name tag): ……………………………………………………………………………
ADDRESS: …………………………………………………………………………………………………..
……………………………………………………………………….POST CODE …………………………
HOME TELEPHONE: :………………………………… MOBILE: ……………………………………….
EMAIL: …………………………………………………………………………………………………………
CHURCH AFFILIATION: …………………………………………………………………………………….
Special needs (diet, medical, physical)? …………………………………………………………...................
…………………………………………………………………………………………………………………..
Name of the person who recommended PFK to you…………………………………………………….
“I would like to participate in Preparation for Kairos, a weekend residential program of spiritual refection and
information about Kairos Prison Ministry Australia. I understand that Kairos is a Christian ecumenical
ministry that is conducted for prisoners and juvenile offenders, and their relatives. I understand that
participation in Preparation for Kairos does not guarantee future participation in the Kairos prison ministry or
commit me to becoming a Kairos volunteer.”
SIGNATURE: ……………………………………………………… Date: …………………………….
Participants will be required to pay the contribution to cover the cost of meals and accommodation.
$100.00 per person shared rooms with shared bathrooms
No one will be precluded if money is a difficulty. There is always a solution
Please return completed form by 8 May 2015 to:
Canberra Monaro KOW PO Box 3961 Weston ACT 2611 or email [email protected]