Home Congregation:
First name:
Last name:
Street Address:
City:
State:
ZIP:
Phone:
E-mail (optional):
May Midwest LTC contact you about LTC information?
Other household members that will be observing events at LTC convention.
(These people should share the same contact info as you.)
Provide first and last names, using a separate line for each person. Do not list LTC participants.
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