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Mission u Registration
Mission u 2019
July 26-28, 2019
Central Methodist University
Fayette, MO

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Email *
Note: Email address provided above will be used for sending confirmation letter
Please provide the following information for the person being registered
First Name *
Provide name as you would like it to appear on name tag
Last Name *
Provide name as you would like it to appear on name tag
Gender Identity *
Mailing Address - # *
Number and street, PO Box #, etc.
Mailing Address - City *
Mailing Address - State *
Mailing Address - Zip Code *
Primary Phone # *
Alternate Phone #
Church
District
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Special Needs
Special Dietary Needs
Name of Emergency Contact #1 *
Phone # of Emergency Contact #1 *
Name of Emergency Contact #2
Phone # of Emergency Contact #2
Are there any physical, health, medication, emotional or behavioral concerns we should be aware of to better prepare for your time at Mission u? *
If yes, what is it and what can we do to help address the situation if it occurs? (Note: this information will be kept in confidence and shared only with those having a need to know; e.g. your study leaders, dean, assistant dean.)
Allergies/typical reactions/concerns
Do You Want Computer or Internet Access? *
Required
Type of Registration *
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