Registration Form

PLEASE PRINT THIS FORM AND SEND WITH $50.00 DEPOSIT TO:

LARRY SINCLAIR
P O BOX 1206
FAIRFIELD, TEXAS 74840

REGISTRATION FORM FOR LATHAM SPRINGS CAMP

January 10-14, 2005

NAME_________________________________________________________________________
ADDRESS______________________________________________________________________
CITY, STATE, ZIP_______________________________________________________________
PHONE _________________________________E-MAIL________________________________
(If using credit card phone number is required--Thank you)

PLEASE CHECK THE CLASS, ACCOMMODATIONS, AND YOUR AGE GROUP

WORKSHOP: TECHNIQUES ADVANCED
SPECIAL ADVANCED VENTRILOQUISM

ACCOMMODATIONS:                 MOTEL                                  MEALS
                                                          DORM                                    RV SPACE

AGE GROUP       ( ) 10 OR UNDER   ( ) 13-18      ( ) 19-35       ( ) 36-55      ( ) 56+

Method of payment Check ___ Money Order___ Credit Cart___

Credit Card information: Master Charge___ Visa___ Credit Card number_________________________Exp. date___ ___
Mo YR

FOR YOUR INFORMATION: Aquilla, Texas is located just south of Hillsboro, Texas and
Northwest of Waco, Texas. Directions will be sent to you when you send your deposit.

FOR MORE INFORMATION CONTACT:
LARRY SINCLAIR
P O BOX 1206
FAIRFIELD, TEXAS 75840
903-389-5988
MOBILE: 817-832-2590
E-MAIL: larsin@sinclairministsries.com