Register Online

Registration Form
For more information contact: Edwina Mallery Immaculate Heart of Mary Church P.O. Box 2398 Lafayette, LA 70502 Early Registration (Due by May 29, 2008) Lyke Conference: $150 Rivers Institute: $50 Liturgical Dance Inst.: $50 On-Site Registration (After May 29, 2008) Lyke Conference: $175 Rivers Institute: $75 Liturgical Dance Inst.: $75	Name:
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	Home:	Please list at least one phone number. Include your area code.
	Work:
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	Email:	* (Enter registrant's email or that of the person completing this form.)
	Church:
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	*Sex:**	Male	Female
	Age*:	Under 13	13-17	18-35	36-55	Over 55
		(Chaperone required for registrants 17 and younger) Please complete and return “Parent/Guardian Consent/Waiver Form” for each youth.
	Chaperone:
	Name:
	Phone:

	T-Shirt Size:	S M L XL XXL ($5 extra) XXXL ($5 extra) (Lyke Conference Registrants Only)

		Items for Purchase
	$150.00	Lyke Conference Registration (July 10 - 13)
	$5.00	XXL or XXXL T-Shirt Fee
	$50.00	Pre-Conference (select only 1) Rivers Institute Registration (July 9 - 10) Liturgical Dance Institute (July 9 - 10)
	$50.00	Rivers Institute Music Packet
	Additional Comments

	Please report any problems with the registration process to the webmaster immediately.
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