Mail-in Registration

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" background="0a0785a3.jpg"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>l</B></FONT><B>    </B><B> |     </B><A HREF="index.htm" TARGET="_top" TITLE="l"><U><B>home</B></U></A></div> <div> <A HREF="index.htm" TARGET="_top" TITLE="l"><U>l</U></A>   |   <A HREF="id43.htm" TARGET="_top" TITLE="Conference Schedule"><U>Conference Schedule</U></A>   |   <B>Mail-in Registration</B>   |   <A HREF="id41.htm" TARGET="_top" TITLE="Join NNECA"><U>Join NNECA</U></A>   |   <A HREF="id37.htm" TARGET="_top" TITLE="From the President"><U>From the President</U></A>   |   <A HREF="id18.htm" TARGET="_top" TITLE="NNECA Board Members"><U>NNECA Board Members</U></A>   |   <A HREF="id39.htm" TARGET="_top" TITLE=" Hotel Registration 38"><U> Hotel Registration - 38</U></A>   |   <A HREF="id40.htm" TARGET="_top" TITLE="Registration"><U>Registration</U></A>   |   <A HREF="id25.htm" TARGET="_top" TITLE="Membership"><U>Membership</U></A>   |   <A HREF="id17.htm" TARGET="_top" TITLE="Start a Clergy Association"><U>Start a Clergy Association</U></A>   |   <A HREF="id31.htm" TARGET="_top" TITLE="Sample Diocesan Association Bylaws"><U>Sample Diocesan Association Bylaws</U></A>   |   <A HREF="id30.htm" TARGET="_top" TITLE="NNECA Bylaws"><U>NNECA Bylaws</U></A>   |   <A HREF="id33.htm" TARGET="_top" TITLE="NNECA History"><U>NNECA History</U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="Clergy Support"><U>Clergy Support</U></A>   |   <A HREF="id26.htm" TARGET="_top" TITLE="LEAVEN"><U>LEAVEN</U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE=" Contact Us"><U> Contact Us</U></A>   |   <A HREF="id38.htm" TARGET="_top" TITLE="Highlights of NNECA 37 "><U>Highlights of NNECA 37 </U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="0a1d2b03.jpg"> <div> Membership</div> <div> <I>$65 for active clergy</I></div> <div> <I>$45 retired clergy </I></div> <div> <I>- please include in your registration fee to receive conference discount</I></div> <div> <I>******************</I></div> <div> <A HREF="id39.htm" TARGET="_top" TITLE=" Hotel Registration 38"><U>Hotel Registration</U></A> is separate from Conference Registration </div> <div> you must make reservations yourself</div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Mail-in Registration</I></div> <div> <I>If you wish to register by mail: Please fill out the form below, print & send check to:</I></div> <div> <I>The Rev. Dr. Jim Boston</I></div> <div> <I>NNECA 38 Registration</I></div> <div> <I>224 N.W. "D" Street</I></div> <div> <I>Grants Pass, OR  97526</I></div> <div>  <form action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="FirstName,LastName,Email,Address1,City,State,Zip,Phone,Company,Fax,NNECA member,Special needs,NNECA 38 Registration"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you for registering for NNECA 38 - a receipt will be mailed to you shortly. "><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A request form was submitted"><input type="hidden" name="tlx_EmailTo" value="jtboston@cdsnet.net"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">First Name:<br> <input type="text" name="FirstName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Last Name:<br> <input type="text" name="LastName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="Email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Address Line 1:<br> <input type="text" name="Address1" size="30" maxlength="100"></td> </tr> <tr> <td align="left">City:<br> <input type="text" name="City" size="30" maxlength="100"></td> </tr> <tr> <td align="left">State:<br> <input type="text" name="State" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Zip:<br> <input type="text" name="Zip" size="10" maxlength="10"></td> </tr> <tr> <td align="left">Phone Number:<br> <input type="text" name="Phone" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Diocese:<br> <input type="text" name="Company" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Fax Number:<br> <input type="text" name="Fax" size="14" maxlength="14"></td> </tr> <tr> <td align="left">NNECA member:<br> <textarea name="NNECA member" rows="5" cols="30"></textarea></td> </tr> <tr> <td align="left">Special needs:<br> <input type="text" name="Special needs" size="50" maxlength="200"></td> </tr> <tr> <td> <input type="checkbox" name="NNECA 38 Registration" value="yes"> Add me to your mailing list</td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </div> </td> </tr></table></body>