CMTEC - Candidate Application

Central Minnesota TEC Application Form

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

__FULL___ CM526 Feb 18 to Feb 20, 2012 _________ CM527 Mar 10 to Mar 12, 2012 _________ CM528 Mar 31 to Apr 02, 2012 _________ CM529 Apr 21 to Apr 23, 2012 _________ CM530 May 19 to May 21, 2012 _________ CM531 Jun 23 to Jun 25, 2012 _________ CM532 Jul 14 to Jul 16, 2012 _________ CM533 Aug 04 to Aug 06, 2012 _________ CM534 Sep 22 to Sep 24, 2012 _________ CM535 Oct 19 to Oct 21, 2012 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_______________ 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 health or physical needs? ____________________________________ How did you find out about TEC?(Please use specific names) _________________________________________________ *Age: Must be at least 16 years old or a junior in High School. Total cost of weekend is $75. 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, Fax 320-532-4459. 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: _____________________