Activities Registration

PRISM Activities Registration Form

First Name:

Last Name:

Age:

Gender:

Male
Female
Prefer Not To Specify

Contact Information

Street Address:

Apartment Number

City

State

Zip Code

Home Phone:

Cell Phone:

Email Address:

Arrival and Departure

US Arrival Date:

US Departure Date:

Family Information

Married?

Married
Single

If married, is your spouse in the U.S.?

Yes
No

Spouse's Name

Are your children in the U.S.?

Yes
No

Children's Names:

Other Information

Religion:

Home Country:

University:

Office Address:

Office Phone Number:

Activities

Please mark the activities you are interested in.

Bible Studies:

Women'S Bible Study At Bellefield Church
Evening Bible Study
Other Bible Study

Friendship Partner Program

I'D Like To Have A Friendship Partner.

PRISM Open House

Open House Sunday Evenings From 6:00 To 8:00 At Bellefield Church

Holiday Hosting

Thanksgiving
Easter

Trips

Niagara Falls (Fall)
Florida (December)
Washington DC (Spring)

Other Activities

Cooking Class
Visit An American Church
Weekend Hosting
English Class

PRISM Activities Registration Form

Contact Information

Arrival and Departure

Family Information

Other Information

Activities

Programs & Activities

Latest Events

PRISM