Rural MN Fellows Contact Form, January 2025 Rural MN Fellows Reunion Contact Form, January 2025 Please complete the following online form if you would like to attend the Rural Minnesota Fellows Reunion from Wednesday, January 8 - Friday, January 10, 2025. If you have any questions or experience technical difficulties, please email Ntjohnson@CollegevilleInstitute.org. Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Suffix Preferred First Name Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Enter Email Verify Email Phone*Name of your church or place of service, along with the town or city in which it's located.* Do you need lodging at the Abbey Guesthouse or are you commuting to Campus each day?* Lodging at the Abbey Guesthouse Commuting to Campus each day Do you have any dietary restrictions or needs?If so, what are they? Do you need any disability-related accommodations?If so, what are they? Do you have any environmental sensitivities?For example: fragrance, lighting, sounds. If so, what? Is there anything else you would like us to know? Emergency Contact InformationPlease list an emergency contact.Name* First Last Relationship to Rural Fellows participant:* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Enter Email Verify Email Photo ConsentPhoto Consent*I give Collegeville Institute for Ecumenical and Cultural Research permission to use photographs of me for possible inclusion in the Collegeville Institute website and/or written publications. I grant the right to Collegeville Institute to crop or adjust such photographs at their discretion, and to incorporate such photographs into any or all of their website or written materials, including, but not limited to, brochures, newsletters, pamphlets, and magazine advertisements. Yes No Prior to hitting submit, please review the form to ensure accuracy. Δ
