KOINONIA \ COY-NO-NIA \ (Greek) n: a gathering.
We invite you to be a part of TEXAS KOINONIA WEEKEND #32 in Pottsboro, Texas October 20-22, 2017 at The Prothro Center on beautiful Lake Texoma!
The weekend fee is $165 per person. Your registration form and check are due by August 31, 2017. Please make checks payable to TEXAS KOINONIA. Space is limited, and reservations are on a first-come, first-served basis.
Please mail the registration form below along with your check to:
Robert Grant, 207 Blair Ln., Arlington TX 76014
Questions should be directed to your sponsor.
TEXAS KOINONIA #32 REGISTRATION FORM (PLEASE PRINT)
NAME:______________________________________________
NAME:______________________________________________
HOME PHONE #:________________ OTHER #:_____________
ADDRESS: __________________________________________
CITY/STATE/ZIP:______________________________________
EMAIL ADDRESS______________________________________
BIRTHDATE:______________ SEX: F____M___
ADDRESS: __________________________________________
CITY/STATE/ZIP:______________________________________
EMAIL ADDRESS______________________________________
BIRTHDATE:______________ SEX: F____M___
CHURCH AFFILIATION:_________________________________
SPONSOR’S NAME:____________________________________
SPONSOR’S PHONE:___________________________________
EMERGENCY NAME / PHONE:____________________________
EMERGENCY NAME / PHONE:____________________________
Do you have any physical limitations or diet restrictions? If so, please explain.
___________________________________________________________________________
Waiver of Liability and Hold Harmless Agreement. In consideration of applying for and receiving permission to participate in Texas Koinonia (herein referred to as "Koinonia") activities, I hereby voluntarily assume full responsibility for any risks of loss, property damage or any kind of personal injury sustained by me as a result of being engaged in such an activity, whether caused by the negligence of officers, team members, any worker or other participants (herein referred to as "Releasees"). Further, I hereby agree to indemnify, hold harmless, release, waive, discharge and covenant not to sue the Releasees from any and all liabilities, claims, demands, actions and causes of actions whatsoever incurred in participation by me or property belonging to me while in association in all Koinonia activities.
In signing this release, I acknowledge and represent that I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and full competent; and I execute this release for full and complete consideration fully intending to be bound by the same.
In signing this release, I acknowledge and represent that I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and full competent; and I execute this release for full and complete consideration fully intending to be bound by the same.
_________________________________________ ___________________
Signature Date
