Meeting and Registration Form National Via de Cristo Gathering 2015 entered in Christ Thursday, July 23 through Sunday July 26, 2015 Augustana College, Rock Island, Illinois 61201 Hosted by Living Water Via de Cristo “…everyone who thirsts, come to the waters.” Isaiah 55:1 One form per person attending. Name First ***PLEASE PRINT*** Last Payment must accompany form. ☐ Male ☐Female Name for Nametag Address City, State, Zip Home phone Cell Phone E-mail Address Fax Home Secretariat Position on Secretariat Position in 2015 (please check all that apply) ☐ NLS Board Member Speaker Lay Delegate ☐ Lay Visitor ☐ Clergy Delegate ☐ Visiting Clergy First Time attending NLS Annual Meeting/National VdC Gathering ☐Yes ☐No If no, please indicate last year attended Position _____________________________ Residence hall is located up a hill from the meeting rooms, about a 7-minute walk. Shuttle service will be available. Please help us plan! ☐ I require on-site transportation assistance I require special accommodations for the following: ☐ Medical ☐ Dietary ☐ Physical Please explain: Travel to National VdC Gathering will be by ☐Auto ☐Air I will need to be picked up at MLI ☐Yes ☐No Transportation will be provided to/from Augustana and Quad City International Airport, Moline, IL (MLI) You must submit the separate Travel Information Form to make a reservation for airport pick-up Are you renting a car? ☐Yes ☐No What day will you be leaving the annual meeting: ☐Saturday PM ☐Sunday by noon $220.00 _________ _________ _________ _________ _________ _________ Registration fee includes meals, housing, materials Thursday 11:00 a.m. thru Sunday 11:00 a.m. Early Registration discount -$20 ($200 if mailed before May 1, 2015) Late Registration +$30 ($250.00 after June 15, 2015) Double Room Roommate requested: ______________________________________ Single Room requested, additional fee of $45.00 ($15.00 per day) Extra night on Wednesday (per person) Double $35.00 Single $50.00 Extra meals (total) (check all that apply) ☐ Wed. Lunch $10 ☐ Wed. Dinner $13 ☐ Thurs. Breakfast $7 DAY RATE $40 per day (includes lunch & dinner) for those not staying on campus TOTAL *** MAKE CHECKS PAYABLE TO: 2015 NLSAG-LWVdC Mail completed Registration Form, Travel Form and Payment to: VdC National Gathering c/o Twyla Lingard 2925 15th Ave. Rock Island, IL 61201 E-mail: [email protected] Phone: (309) 786-4520 Registration Use Only Ck rec/number Transportation Date Rec Air Travel Information Form Via de Cristo National Gathering 2015 entered in Christ Thursday, July 23 through Sunday, July 26, 2015 Augustana College, Rock Island, Illinois 61201 Hosted by Living Water Via de Cristo “…everyone who thirsts, come to the waters.” Isaiah 55:1 PLEASE PRINT Name - First Last Home Phone Cell Phone Work Phone Fax E-mail Address Host Committee will arrange transportation between Augustana College and Quad Cities International Airport. (approx. 20 minutes to Augustana) Do you need ADA accessible transportation? ☐Yes ☐No If yes, please explain: ARRIVAL: Date:______________ Arrival Time:____________ Airline:____________________________ Flight #:_________ Departing City: ______________________________________ Departing Airport:_____________________________________ Connecting City: ____________________________________ Connecting Airport:___________________________________ Number of people traveling with you on this flight: ______ Names: _____________________________________________________________________________________________________ DEPARTURE: Date:______________ Departure Time:____________ Airline:____________________________ Flight #:_________ Number of people traveling with you on this flight: ______ Names: _____________________________________________________________________________________________________ Alternate Travel Options: ACT II Transportation provides shuttle service from Chicago airports to the Quad Cities. Amtrak passenger train service is available to Galesburg, IL (about 40 miles from the QC). Please contact us for additional Information. We will do our best to accommodate your travel plans with advance notice. Note: If there are any changes to your travel arrangements after you send this form, please e-mail Twyla Lingard at the address below. Mail completed Registration Form, Travel Form and Payment to: VdC National Gathering c/o Twyla Lingard 2925 15th Ave. Rock Island, IL 61201 E-mail: [email protected] Phone: (309) 786-4520
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