First Name:                                             
Last Name:                                       
Name for Badge:                     
Organization:                           
Address:                          
City:                                 
State:                               
Zipcode:                           

Daytime Phone:                
Fax Number:                    
Email (required):               

Preferred Sessions (these choices are not binding):
First Session            1A  Edmond Yomtoob          1B  Jeanne Malnati
Second Session        2A  Fr. Charles Rubey          2B  Dr. Ann Cusack

CEU Information:
I am requesting CEU's (your registration packet will include a form for you to fill out and submit in order to receive your CEU'S, which will be awarded through CTU.)

Conference Fees:

     $35 - Regular Conference Rate
         $30 - Conference Rate before July 1, 2008

         $20 - Student Conference Rate
         $17 - Student Rate before July 1, 2008

Lunch:
Due to our tight schedule, we recommend that you plan to stay on site for lunch. Subway will deliver to us.  Please indicate your choice of options.

I will be bringing my own lunch.

OR

Enclose $6.50 for a Subway lunch (6" sandwich, 1 pop, chips & cookie)
               
        Select one:  Turkey   Ham    Roast Beef   Veggie
        Select one:  Coke      Diet Coke     Sprite

Add an additional $3.50 for an extra sandwich

        Select one:     Turkey   Ham  Roast Beef  Veggie

Add an additional $1.00 for a pop

         Select one:  Coke      Diet Coke     Sprite

TOTAL REGISTRATION AND FEES:

    Conference Registration:                       
    All Lunch Fees:                                     

TOTAL AMOUNT OWED:           

Payment Options:

To pay by check or Money Order: 
I will mail my check payable to Stauros USA and the registration form to the conference registrar at: 
T.M. Enterprises
8404 Jamesport Drive
Rockford, IL  61108

OR

To pay by MasterCard or Visa:
Complete the form below.  Note when you receive your credit card statement the conference fees will show on your bill from T.M. Enterprises, A Division of Rockford Management Services, LLC - Rockford, IL. 

MasterCard or Visa Number:            
Expiration Date:                           
Name on the Card:                       

Area of Interest/Focus (may check more than one):
    Parish Staff / Pastor                                  Campus Minister
    Survivor of suicide death                           School Teacher / Administrator
    College / Graduate Student                       University Professor
      Psychologist / Counselor                          Other:  Please list: 

Contact Information:

Registration Questions:  Call the registrar at 815-332-7084  or E: TMEnter2@aol.com  or Terry@TMConferenceServices.com

Conference Questions: Call Stauros at 773-484-0581

CEU Questions: Call Keiren O'Kelly at CTU at 773-371-5442