CURSILLO DE CURSILLOS
Archdiocese of Seattle Cursillo Movement
November 18-21, 2010
Lakeview Christian Retreat Center 
4005 S. 360th St., Auburn, WA, 98001 


REGISTRATION FORM

Cost for the Cursillo de Cursillos is $100.00 if paid in full by October 15, 2010

(Please use a separate form for each cursillista attending)

(TYPE OR PRINT LEGIBLY - THANK YOU ** FILL IN ALL THE BLANKS)

Preferred Language:  ________________________________________________________________

(The CDC will be in English. There will not be simultaneous translation.)

Last Name: _______________________________ First Name: _______________________________

Preferred Complete Name for Name Tag: ________________________________________________

Address: ___________________________________________________________________________

City: ______________________________________ State: __________ Zip Code: ______________

Home Telephone: ___________________________Work#: ____________________________________

Cell Telephone:____________________________Fax#:______________________________________

E-Mail Address: __________________________________ Diocese: __________________________

Age group (Circle one):       Under 25       26-35        36-50       over 50

Health (Circle one):          Excellent      Good         Fair        Poor

Gender (Circle one):          Male            Female

Spouse attending?   Yes_____   No______

Roommate preference? (Circle One) Yes:___No: ___ If Yes, Name: ___________________________

Special needs (dietary/handicap/walking or problems with steps/etc.):  _________________________

Date you lived your Cursillo and where: __________________________________________________

Are you currently a member of a School of Leaders? Yes:___No:___ If Yes, SOL Name:_________________

Are you currently involved in music ministry? Yes:______ No:______ 

Would you like to be part of the Liturgical Team for the CDC? Yes:______ No:_______ 

SEND FORM AND PAYMENT TO:

Seattle Cursillo Movement
P.O. Box 68803
Seattle WA 98168-0803 

Telephone: (425) 466-6808, Fax: (425) 706-7329, e-mail: jablakeley@hotmail.com

Registration cost will be $100.00 per person until October 15, 2010.
Registration cost will be $150.00 per person after October 15, 2010.