Central Minnesota TEC Application Form


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

_________ CM597 Aug 05 to Aug 07, 2017 _________ CM598 Oct 20 to Oct 22, 2017
_________ CM599 Nov 24 to Nov 26, 2017 _________ CM600 Dec 29 to Dec 31, 2017
_________ CM601 Jan 13 to Jan 15, 2018 _________ CM602 Feb 17 to Feb 19, 2018
_________ CM603 Mar 24 to Mar 26, 2018 _________ CM604 Apr 14 to Apr 16, 2018

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: _____________________