Purposeful Adult Registration 2010 The following form is to be printed and completed by adults who will be traveling with the group in August 2010 First Name:(as listed on pasport) Last Name: (as listed on pasport) Email Address: Home Address: City, State: Zip Code: Home Phone: Cell Phone: Type of Room Needed    Single or Double Room    (circle one) Are you traveling alone? Who is traveling with you? Your Passport Number Your church home Please read the attached Terms and Conditions and sign below I have read the above terms and conditions Signature: _______________________________________________________ Date: _____________________________ Mail registration form and deposit to: JASAC, P.O. Box 292322 Sacramento, CA 95829

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