Simply Smiles Service and Learning Trip 2020

Annual Mission Trip to the Cheyenne River Sioux Reservation in South Dakota from May 9 - May 16, 2020. A $200 refundable depoist is required to reserve a space on the trip.

Please Help Us Stay In Contact With You!

Please follow these instructions:

  • Always use the same email address when registering for Conference events. If you are using a different email address than what you have used previously, please check the "Change in Information" box.
  • If you are registering a group, please Do NOT repeat use of a single email address for each participant. Provide each person's email address, or leave the field blank if you do not know their email.
  • Use your full first name in the First Name field. If your prefer to go by a different name, please put that in the "Preferred Name" field. (For example, you might put "Robert" in the first name field and "Bob" in the preferred name field.
Who is filling out this form?
First Name
Last Name
Email
Who are the participants?
*First Name *Last Name *Preferred Name Address 1 Address 2 City State Zip Email
Preferred Phone Number
Indicate Type of Phone
*Has your contact information changed?


If you are changing the contact information previously provided to the Conference, check YES.

If it is the same, or this is your first registration, check NO.

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*What is your preferred pronoun?

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If your state is not listed please us the "Other" option.

Connecticut
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Please tell us where you are from
*Connecticut Church Names

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*Massachusetts Church Name

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*Rhode Island Church Names

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*New York Churches
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You can opt out any time via a link in the newsletter. If you already receive it, nothing will change. 

Privacy

Please note that the Massachusetts, Connecticut and Rhode Island Conferences sometimes take photographs and record video at Conference events for use in Conference publicity materials in print, online and in social media. If you have concerns about appearing in these materials, please contact Tiffany Vail, Associate Conference Minister for Communication, at vailt@macucc.org, and we will do our best to address them.

We will not share your private information with outside organizations.

**Name as it appears on your passport

Please use the name that matches your photo identification for airport security.

**Birthday

Necessary for purchasing air transportation

I am interested in financial aid from my home church, if available.
*Sign Me Up ($200)

I am submitting a $200 deposit and understand I will receive a reminder to pay the balance which will be approximately $1200.

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