Equip and Refresh Day - Application Form @

Alpha WALES

We don't have an electronic payment facility so you will need to fill out the form on screen then print it and post to:
Vera and Brian Lloyd, 37 Normandy Way, Chepstow, NP16 5NB

Your details:
Title:	[select from list] Mr & Mrs Mr Mrs Miss Ms Dr Revd
First Name/s:
Last Name:
Address:
Post code:
Telephone - Day:
Telephone - Evening:
Email address:
Church:
Denomination:

     

Please tick the relevant boxes below:

I am new to running Alpha

I have run an Alpha Course before

I have not attended an Alpha Conference or Equip and Refresh Day before

I have attended an Alpha Conference or Equip and Refresh Day before

I would like to apply for place(s) and enclose a cheque for £ @ £10 per head (includes materials and food), made payable to Chepstow Methodist Church

Names of additional delegates:	Attended a Conference before?
	Yes  No
	Yes  No
	Yes  No
	Yes  No
	Yes  No
	Yes  No

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