2018 CCM LEADERSHIP SUMMIT ENROLLMENT FORM

October 19-21, 2018 Saints Grove Campground, Glencoe, OK

Registration: (Fill-in form on computer, save, print out for e-mailing, OR print form and hand write info send in the mail.)

Street/P.O. Box	City	State/Province	Country	Zip Code/Mail/Code

Registrant/Registrants

Last Name	First Name	Home Phone	Cell Phone	E-mail Address

Housing Preference: Please check one:

______ Lodge: Lodge rooms will be assigned on a first-come, first-serve basis. The rooms in the lodge accommodate four people

per room and have two bunk beds. All rooms are air conditioned. You must bring your own bedding.

______ Cabins: There are six cabins that have three bunk beds per cabin that will accommodate six people.

There are eight cabins that have four bunk beds per cabin that will accommodate eight people.

______ Recreational Vehicles: RV full hook-ups are available

Roommate Preference: __________________________________________________________________________________

Registration Costs: $60/Person, $140/Family Max* Number Per Family (Age 3 And Over): (1) __________ (Infants 2 And Under Are Free) Total Fee: (line 1 x Amount $60) (2) $ _________ Note: Medical Enrollment Form and Medical Card will need to be presented at the time of registration. Transportation: Transportation pick up is available for flights arriving and departing the Tulsa Airport. ATTENTION: More information about the Summit is available on the CCM Website at ccm4you.com. Ck it out!	Payment- include with this Enrollment Form, a check or money order (USD) payable to “CCM” and mail to: Linda Stephen, 221 Ohio Street, East Alton, Illinois 62024 Phone: (314) 662-3662 Email registration: Email: stephenldlv2u@yahoo.com Payment may also be made at registration (at the door) Customer Service Contact: Questions about the event or registration-Please contact Sandie White at (918) 730-8689. Special Dietary or Ambulatory Requirements: __________________________________________________