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The Agapé Center for Service and Learning

Learning with our Head, Hands, and Heart

 

 

Registration Form

Conference registration is free for members in the Messiah COE. The registration fee is $75 for commuters and includes meals. A single occupancy air-conditioned apartment costs $55.65 extra for your stay.  Conference dress is casual.

 

Registration for this conference is non-refundable. Please contact us if you have any questions.

  

 

 

  

   


Please fill out the form below to register for the conference.

 

Fields marked in red are REQUIRED.  
Fields marked with an asterisk (*) will appear on your name tag.

 

 

Registration Type

Commuter Registration (Includes housing) $130.65

Commuter Registration (No housing) $75

Personal Information

 

* Title:
* First Name:  * MI:
* Last Name:  
Address:  
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email Address:  
* Position Title:
* Institutional Affiliation:
Special Dietary Considerations:
Other:
Requests for assistance:
Any other considerations:

Transportation

 
Probable mode of transportation:
Flight Information for Harrisburg International Airport (MDT)
Arriving to the Conference:  
Place of Departure:
Flight Number:
Arrival Time at MDT:
Departing the Conference:  
Departure Time from MDT:
Flight Number:
Place of arrival:
Train Information  
Arrival Time:
Departure Time:
Departure Location:
Destination Location:

Emergency Contact Information

This information will be kept private and only will be used in the event of an emergency.

Name:
Relationship:
Phone number:
Your cell phone number:

Check here if you are interested in single occupancy rooms for an additional $15.00 a night.