Spirit of the Earth Church Inc.
West KY Hoodoo Rootworker Heritage Festival 2011 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: ________________________________________________
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 pre-registration ends Friday September 9th, 2011 at midnight.
WEEKEND RATE:
Adults $40: ________
ONE DAY RATE:
Adults $20: _________
*Please indicate which day you will be in attendance: Friday Saturday Sunday
SOTE MEMBER (25% DISCOUNT):
Weekend: Adult _______
One-day: Adult________
*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 -5pm central time
