150th Anniversary
Celebration Dinner Event 
October 9, 2004
Registration Form

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Adults will have a catered buffet meal for $12.00 per person and the children
will have pizza, drinks, homemade cookies, munchies, movies, games and
supervised play time in the conference room and/or nursery - all for $3.00 per
child.  An informal reception upstairs in the Parlor begins at 4:00 followed by
the dinner downstairs in the Fellowship Hall which begins at 5:15 P.M.  
     *** The deadline for registering is Friday, October 1, 2004. ***


Last Name _______________________

First Names of Adults Attending:       _________________
   (@ $12.00/person)
					_________________

					_________________
								
					_________________


First Names of Children Attending:	_________________
  (@ $3.00/child)
					_________________

					_________________

					_________________	

Total Amount Included with this registration:                           $______________

Please send ticket receipt to us at the following address:

______________________________________

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PLEASE RETURN THIS REGISTRATION FORM WITH YOUR PAYMENT TO THE CHURCH OFFICE - 805 S. 6TH, CHAMPAIGN, IL  61820

REGISTRATION DEADLINE:   FRIDAY, OCTOBER 1, 2004