Columbus Koinonia - Online Application

If you are interested in attending a Koinonia weekend, please completely fill out the following application and then submit it to us by hitting the submit button on the bottom of this form.
The cost of the weekend is $80 per person. A deposit of $40, (half), must be mailed in when you submit this form.
The remaining $40 is due by the weekend. Someone will call you with a mailing address after you submit your application.

Please fill in all blanks.
First name*
 Last name*
Nickname*
 Date of Birth*
Street address*
City*
 State or Province*
ZIP or Postal code*
 Phone Number*
Marital Status
 E-mail address*
Church Affiliation*
Church Phone Number*
Age and sex of any children?
Special Diet or needs?
General Physical Condition or special needs?
Play an instrument?
 E-mail address*
Special Diet or needs?
Comments:
***********************************************
In case of Emergency notify
Phone number
 Fax number
***********************************************
Applicants Signature/Name
Phone number
 Fax number
Best time to call
 E-mail address*
***********************************************
Sponsor's Name - (Sponsor's info in Blue)
Street address*
City*
 State or Province*
ZIP or Postal code*
Phone number
 Fax number
Best time to call
 Sponsor's E-mail address*
Sponsor's Comments: