Appln Participation Tuross PFK May 2015
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]
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