CityLights Urban Project

STAFF REGISTRATION PAGE
Cost for staff is $125. One staff can come free for every 7 students that come from your chapter. Your staff account will be charged during the week that you attend CityLights unless you chose to pay by check at onsite registration.

1. Full Name Required Question

2. Name you prefer to be called:

3. Gender

	Male
	Female

4. Ethnic Heritage

5. College / University you staff:

6. Date of Birth: Required Question

7. If you are married are you coming with your spouse? Required Question

	Yes
	No
	I'm not married

8. Current Address: Required Question

Address1
Address2
City
State
Zip

9. Contact Information:

Cell Number
Home Number
Email

10. Emergency Contact Information: Required Question

Contact Name:
Relationship:
Phone:

11. Medical Insurance Information: Required Question

Insurance Company
Policy#

12. Date of your last Tetanus shot: Required Question

13. If you've been to CityLIghts before what year(s) did you come?

14. Musicality & Worship Questions

List any instruments you play:
Would you be willing to help lead some informal times of worship?

15. Rate your experience level below using the following scale
   1 - no experience
   2 - a little experience
   3 - considerable experience but need supervision
   4 - skilled and can work without supervision:

	1	2	3	4
Plumbing
Drywall
Asphalt sealing
Laying floor tile
Landscaping
Painting
Auto repair
Web page design
Masonry
Carpentry
Electrical
Visual arts

16. List any languages you are fluent in:

17. How will you travel to St. Louis? Required Question

	Drive
	Fly
	Other

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copyright 2009 | InterVarsity Chrsitian Fellowship