Your Name

First Name

Last Name

English Name (if any)

Email Address

Please Re-type Email

Phone Number

(###)

###

####

Gender

Female

Male

Family members name(s) and ages (if under 18)

If bringing family, list their full names below. Children under the age 8 must use a car or booster seat. State below if you need one. Otherwise, enter "NO"

Friend's full name(s)

If bringing friends, list their names below. Otherwise, enter "NO"

Transportation

If you select Options 2 or 3, it means you have a valid US drivers license, and an auto with valid insurance.

Option 1 - I (and any family/friends I registered) need a ride. I agree to bring $2 cash to help our driver buy gas.

Option 2 - I can drive myself (and my registered family/friends,) I request directions and an address in advance because I will not report to CXI House on the way to the event that day.

Option 3 - I can give a ride to other CXI-assigned guests. I will arrive to CXI House 10 minutes early.

Below is the number of riders I have space for.

Required for Option 3.

Comments or Questions?

Thank you for registering for an upcoming event offered by Connexions International! We will send you more information as the date gets closer. We look forward to meeting you then.