Spirit of the Earth Church Inc.

BELTANE 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: _________________________________________

Adult Legal Name: _________________________________________

Address: ____________________________________________________

City: _______________________State:_____________________Zip:________

Country: ______________________ Home Phone: _______________________

Cell Phone: _____________________

E-mail:________________________________________________

E-mail: ________________________________________________

Minors: (please list your child/children below. Please note that you must be the parent or legal guardian of the child you are registering!)

Name:_________________________________________Age:______________

Name:_________________________________________Age:______________

Name:_________________________________________Age:______________

Name:_________________________________________Age:______________

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.

Early pre-registration ends Friday March 9th, 2012 at midnight.

WEEKEND RATE:

Adults $50: ________    Children $25:_________

ONE DAY RATE:

Adults $30: _________ Children $15: ___________

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

SOTE MEMBER (25% DISCOUNT):

Weekend: Adult _______        Child________

One-day: Adult________          Child________

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

Additional tax deductible donation: $________________

Total Amount Enclosed: $_____________

Signature: ____________________________________ Date: ____________________

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