Write To Soul Registration Form Date: Thursdays, September 1 – October 20 Time:  10:00am - 11:30am Location:  TBD Cost:  $150 Maximum Participants: 8

Contact Information First Name Last Name Place of Ministry Title Address Address 2 City State Zip Phone Cell Phone Email Event Date Sept 1 - October 20 Cost $150 Health Information Emergency Contact Emergency Contact Phone Number Please list any allergies/health issues. Please list any special dietary requests, i.e., vegetarian, dairy free, etc.