CFI

Crowe Academy Registration Form
Complete this form, print and mail to:

Center for Free Inquiry - Crowe Academy
PO Box 108 - Hanover, IN 47243

Make check payable to: Crowe Academy.
Registration is limited to first 100 people!

Name
Address
City State Zip

Phone Email

**************
Check one box.
I will need a room for people. I will not need a room.
I prefer Greenwood Ogle File (for women only)
I do not have a preference.

I need handicap access. I need a first floor room.
Explain any dietary needs or restrictions: ________________________________
**************
I am a graduate of Hanover College. Year:
**************
Check one box

Enclosed is my deposit of $75.00 per person. June 1, 2008 is the deadline for deposits. After June 1, please send the full registration fee.

Enclosed is my full registration fee of $350.00 ($290.00 for those who don't need a room) per person. I understand that my readings will be sent to the address above immediately. June 16, 2008 is the final deadline for registration.

I also wish to become a Patron of Crowe Academy and have enclosed an additional $200 or a Special Patron for $500 or more.

**************
Credit Card Information
Name as it appears on the card:
Amount to Charge
Card Account Number
Expiration Date: Type of Card: Visa - MC

3-digit V-code from signature box on back of credit card:

Total to be charged:

Card Holder's Signature ____________________________ Date _______

Please proof read all information after printing.

For Illinois Continuing Education Credit for High School Teachers: A 3-5 page synopsis of the three-day program must be submitted for our archives no later than July 31, 2008. It is the responsibility of the teacher to complete the appropriate forms.

Become a Patron of Crowe Academy