Hoodoo-Mail-In-registration

Spirit of the Earth Church Inc.

WESTERN KY HOODOO ROOTWORKER HERITAGE FESTIVAL

2012 REGISTRATION FORM

Complete this form, enclose minimum contribution rates, and mail to

Hickory Grove 2740 Gospel of Peace rd Hopkinsville, KY. 42240

*checks or money orders should be made out to Spirit of the Earth Church

Adult Legal Name: _________________________________________

Address: ____________________________________________________

City: _______________________State:_____________________Zip:________

Country: ______________________ Home Phone: _______________________

Cell Phone: _____________________

E-mail:________________________________________________

E-mail: ________________________________________________

Please list any special needs or medical conditions that we may need to be aware of:

________________________________________________________________________

Select from the options below, please indicate how many people will be in attendance.

Mail-in registrations must be postmarked by Friday September 14th, 2012. Registration rates are as follows:

3/10 - 5/11

5/12 - 7/13

7/14 - 8/14

Weekend $60

$75

$90

$105

One Day $25

$35

$45 $55

WEEKEND RATE:

Adults $60: ________

ONE DAY RATE:

Adults $25: _________

*Please indicate which day you will be in attendance: Thursday Friday Saturday Sunday

SOTE MEMBER (25% DISCOUNT):

Weekend: Adult _______ Child________

One-day: Adult________ Child________

*Please indicate which day you will be in attendance: Thursday Friday Saturday Sunday

Additional tax deductible donation: $________________

Total Amount Enclosed: $_____________

Signature: ____________________________________ Date: ____________________

*Registration confirmation and address to Spring Ledge Farms will be sent upon receipt of registration form.

Questions?

Contact the Spirit of the Earth Church office at (270) 874-2896

Monday- Friday 9am -4pm central time