Midwest Prom 2012 Registration - Midwest Teen Prom

Evening of Elegance Midwest Teen Prom Saturday, April 28, 2012 Columbus, Ohio REGISTRATION

Family Name ________________________________________________ Prom attendees: _____________________________ Age:____________ _____________________________Age:____________ _____________________________Age:____________ Are any of above Prom attendees graduating from High School this year? Y or N If yes, please also mail Senior Questionnaire with this registration. Cost is $34 per attendee. Please make checks payable to United Church of God, Columbus. Mail registration to:

Michelle Waterhouse 8773 Springflower Drive Pickerington, OH 43147

Please print your Email address for us to send reservation confirmation: _________________________________________________