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Receiving the Word
(Jeff Sewell, Coventry East)

November 13th 2004

Booking Form
Derby Bass Street Youth Day
November 13th
(God willing)
Name
Age
Address
Postcode
Tel. No.
Email Address
Meeting
Baptised
Yes No
Gender
Male Female
How will you be travelling?
Will you be driving your own car?
Yes No
Will you need picking up from bus or train station?
Yes No
Require Accommodation?
Yes No
Require a Photograph?
Yes No
Dietary requirements (if any)

The cost for the day will be £8.00.

Please send payment by to:
MISS L. NEWMAN,
38 Melbourne Close, Mickleover, Derby DE3 5LG

Please make cheques/postal orders payable to:
DERBY BASS STREET CHRISTADELPHIAN ECCLESIA