Cornerstone Application 
Spring 2002
The cost of Cornerstone is $25, which pays for food, lodging, and other materials throughout the weekend.  Scholarships are available if needed.

Name__________________________________________

Current Address________________________________________

City/State/Zip__________________________________

School(if applicable)_____________________________________

E-mail______________________		

DOB____________Age____________Sex___________

Permanent Address________________________________________

City/State/Zip__________________________________
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Person to Contact in Case of Emergency:

Relationship to You___________________Phone#__________________

Special Dietary Needs:_______________________________________________________
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I have completely filled out this application and enclosed my $25 (checks payable to Vocare in Mississippi):

Signature:________________________________Date_______________
Mail to:	Lauchlin Fields
		1004 South 16th Street
		Oxford, MS  38655
		662.234.6290
		cornerstonems@yahoo.com