Name: ______________________________________________
Address: _____________________________________________
City: _________________ State: ______ Zip: ___________
Home Phone: ___________ Cell Phone:_______________
e-mail:_______________________________________________
Home Church: ________________________________________
Send this form along with $20 for adult or $5 for students to:
F.O.C.A.S. c/o James Shelton 338 Wildflower Way Cadiz, Kentucky 42211