THIS FORM IS FOR WESTERN NC CONFERENCE INFO ONLY.
YOU WILL NEED TO REGISTER FOR THE STUDENT FORUM AT

www.umsm.org/studentforum

The student forum costs $140. Transportation will be arranged by the conference at $50 per person.

Participant Information

First Name

Last Name

Sex

Birth Date

Year

College / University

United Methodist?

Yes - I am a rostered United Methodist

No - I am not a United Methodist

Home Church (Church Name, followed by City & State)

CONTACT INFO

Address 1

Address 2

City

State

Zip

Phone

Alternate Phone

Email Address

Student Forum Information

Each participant will be involved in a conference-wide Immersion Field Trip. Rank the options below in order 1 being the best option, 12 being the worst option. It is our goal to have one student from the Western NC Conference in each field trip.

	Politics and Religion Institute
	Homelessness, Poverty, and Hunger
	Racism of Mascots
	Gentrification
	Immigration
	Employment & Living Wage
	Women's Rights
	Environment
	Civil Rights
	Education in America
	Health Care
	HIV/AIDS Awareness

Will you apply to lead a small group?

Yes I plan to apply

No I will not apply

Shirt Size

The Western NC Conference will provide roundrtrip transportation from the Greensboro/W-S area. Please plan to be in the W-S, Greensboro area no later than 8am on Thursday May 22. The transportation cost will be $50 per participant, a cost your college campus ministry may want to supply. If you have special circumstances that prevent you from traveling with the group (i.e. you live in DC or nearby), please email steve [at] campus-ministry.org asap.

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