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Registration - 2024 - Reunion - Onset
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Primary Participant
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Address
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Congregation
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Gales Ferry, CT
Hartford, CT
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Warwick, RI
Attleboro, MA
Avon, MA
Lexington, MA
Onset, MA
Beals, ME
Brewer, ME
Comunidad de Cristo, ME
Ellsworth, ME
Freeport, ME
Jonesport, ME
Machias, ME
South Addison, ME
Stonington, ME
Vinalhaven, ME
Other…
Enter your congregation…
Priesthood Office
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Deacon
Teacher
Priest
Elder
High Priest
Seventy
Evangelist
Bishop
Are you allergic to any foods, latex, medications, etc.?
Yes
No
Please list your allergies.
Are you presently under a physician’s care for any acute/chronic medical condition?
Yes
No
Please list your acute/chronic medical conditions.
Are you currently taking any medications?
Yes
No
Please list your current medications.
Please list any mental health or physical conditions.
Have you recently been exposed to a contagious disease or illness?
Yes
No
Please list any contagious diseases or illnesses you've recently been exposed to.
Do you have any special dietary needs?
Vegetarian
Vegan
Gluten-free
Dairy/lactose-free
None
Other…
Enter your dietary needs…
Physician Information
Physician Name
Physician Phone Number
Insurer name
Insurance card number
Please attach pictures of the FRONT of a current health insurance card that covers you.
Upload
One file only.
4 MB limit.
Allowed types: gif, jpg, jpeg, png.
Please attach a picture of the BACK of a current health insurance card that covers you.
Upload
One file only.
4 MB limit.
Allowed types: gif, jpg, jpeg, png.
Are you interested in being in the choir for reunion?
Yes
No
Do you require housing?
Yes
No
Please describe your housing requirements.
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