Northeast Pennsylvania Synod


Northeastern Pennsylvania Synod
Campus Ministry Overnight
November 9 & 10, 2007
Cost $10.00

Name:  
Permanent Address:  
City:  
State:  
Zip Code:  
Phone Number:  
Cell Number:  
College/University:  

Medical Information

Name of Person to Contact in Case of Emergency:
   
Phone Number:  
Relationship:  
Any allergies to foods or medicines?
   

Please complete this form online or click here to print and mail to : Peter Bredlau, Muhlenberg College, 2400 Chew Street, Allentown, PA 18104

Call 484-664-3120 or email pbredlau@muhlenberg.edu with questions.


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