Registration

Please print form and fill out the information below

(please print)

Name__________________________________________

Address________________________________________

City___________________________________________

State__________________Zip_____________________

Home Phone____________________________________

Cell Phone_____________________________________

E-mail_________________________________________

Church Membership______________________________

Tribe__________________________________________

                                                              Quantity

Men                $10                              _______

Youth              $10 (ages 12-18)             _______

Amount Due                                           _______

Payment enclosed (make check payable to Cornerstone Indian Baptist Church)

Mail Registration Card and Payment to:

Cornerstone Indian Baptist Church

17020 E. Tecumseh Rd.

Norman, OK  73026