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Midwest Leadership School Registration Form   (page 1 of 2)

  • A printed copy of this form may be used in lieu of the form printed in the MWLS Brochure. It is helpful if all registrations from one congregation (up to the maximum of four) are mailed in on one form.
  • Include payment as indicated below.
  • Congregation fee in full: $500
  • A $150 deposit per registrant (in addition to the Congregation fee) must be included. Any part of the remaining $345 tuition may also be paid now. Any remaining balance is due June 1, 2008.
  • Please notify the Registrar immediately in case of cancellation.
 

Mail registration form, deposits, and society fee to:

MidWest Leadership School
c/o Jan Steinmark, Registrar
927 Royal Avenue
Evansville, IN  47715
(812) 473–3915
Email: jansteinmark@yahoo.com

Congregational Information

Cong. Name ___________________________________________
Address ___________________________________________
City, State, Zip ___________________________________________
District ___________________________________________
Phone (_____)____________________________________
Email ___________________________________________

Minister, Board Chair, or President's Signature of Recommendation

Name ___________________________________________
Title ___________________________________________
Signature ___________________________________________

Payment (make checks out to “MidWest Leadership School”)

Total Society Fees (must be enclosed) :
($500) 		  $ ______________
Total non-refundable Tuition Deposits (must be enclosed) :
($150 for each registrant) 		  $ ______________
Optional additional tuition payment :
($345 additional tuition for each registrant is due June 1, 2008) 		  $ ______________