Name ____________________________ Phone ( ) _______ - _______________

Address __________________________ City __________________________________

State ___________________ ZIP _______________ E-Mail _______________________

Those in my reunion group: _______________________ ________________________

_____________________ _______________________ ________________________

Where and how often do you meet? __________________________________________

Gold Coast weekend # _______ or where attended ____________________________

Last team # I served _______ Date(s) of Leaders school I attended:_______________

I have served as: Check all that apply:

______ Cha cha _______ Music Cha _______ Head Cha

______ Professor _______ Assisting Professor _______ Rector

______ I have not served on a Gold Coast team, but am interested

List Talk(s) given _____________________________________________________

_____________________________________________________________________

Name of Church where I worship: ________________________________________

Leadership positions in my Church _____________________________________

Name of Pastor/Clergy ________________________________________________

My cost to serve on weekend $75.00

Please Mail Completed Form to:

Gold Coast Via de Cristo Secretariat

Advent Lutheran Church ___________________________

5001 NE 4^th Avenue Signature

Boca Raton, Florida 33431-4903 ____ / ____ / _________

Today’s Date