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Student Ministries T h e Ro c k & Wo r s h i p Ro a d s h ow Thursday, November 3rd Concert Registration Form All forms are due by Saturday, October 29th

____________________________________________________________________ Name ____________________________________________________________________ Address ____________________________________________________________________ City ____________________________________________________________________ Phone

Cost : Free Student Ministries will pay for your ticket. Bring your own money for dinner & purchases.

Meet at Church by 4:00 pm.

____________________________________________________________________ Emergency Contact

As parent or guardian of the student listed above, I give permission for him/her to attend this trip. I authorize the leaders for Essexville Baptist Community Church to represent me in the need for medical treatment. _____________________________________________________________| ___________________________________________ Parent/Guardian Signature Date _____________________________________________________________|____________________________________________ Insurance Carrier Policy #

Invite a friend! Everyone does need a signed permission form. Additional forms are available at the website at This is the concert of the fall! Student Ministries will pay the $10 cost for the concert as well as provide transportation for Middle and High School Students. The church van will leave at 4:00 pm. to the Dow Events Center in Saginaw.

For questions contact: Shirley Reid 989.964.8827

Or Rev. Richard Kinnamon Essexville Baptist Community Church 1001 Main St Essexville, MI 48732 989.892.9892