Central Minnesota TEC Application Form

Dates of Central Minnesota TEC Weekends: (Please choose one)

______ CM609 (Fri) Nov 23-(Sun) Nov 25, 2018 ______ CM610 (Fri) Dec 28-(Sun) Dec 30, 2018
______ CM611 (Sat) Jan 19-(Mon) Jan 21, 2019 ______ CM612 (Sat) Feb 16-(Mon) Feb 18, 2019
______ CM613 (Fri) Mar 08-(Sun) Mar 10, 2019 ______ CM614 (Sat) Apr 27-(Mon) Apr 29, 2019
______ CM615 (Fri) May 17-(Sun) May 19, 2019 ______ CM616 (Sat) Jun 22-(Mon) Jun 24, 2019

The retreat begins at 9:30 AM the first day and concludes at 5:00 PM the third day.

Name ________________________________________ Sex___ Birthday________*Age_____

Preferred Name on Name Tag________________________ Email:_____________________

Permanent Address ____________________________________________________________

City__________________________ State_________ Zip________ Phone_______________

Emergency Phone Number while attending TEC:__________________

Address Used During School Year ______________________________________________

City__________________________ State_________ Zip________ Phone_______________

Marital Status ________________________ Spouse's Name ________________________

Religion___________________ School__________________________ Grad Year________

Parish___________________________________ Pastor______________________________

Parish Address______________________________ City__________ State___ Zip _____

Parent's Name_________________________________________________________________

Do you have any special dietary or health needs? _____________________________

How did you find out about TEC?(Please use specific names) _________________________________________________

*Age: Must be at least 16 years old or in spring semester of sophomore year in high school.

Total cost of weekend is $95. Please attach a non-refundable $30 registration deposit and
mail this form to Central Minnesota TEC, PO Box 8, Andover, MN 55304.
Phone 320-532-4455. Weekends are held in Little Falls, MN.
Phone during a weekend 320-632-1675.  Once your application is submitted you can assume you
have been accepted. Exceptions will be notified by mail immediately.  A letter with full
details regarding the retreat will be sent to you two weeks prior to your weekend.

If you are a student living at home, please ask your parent or guardian to sign this
application and medical waiver. In case of illness or injury, I authorize those in
charge of the TEC weekend that my son or daughter attends, to obtain whatever medial
assistance that seems necessary for his or her well being.

Signed by ___________________________________ Phone: _____________________