Registration : Free Methodist Medical Fellowship Consultation 2004
Name _____________________________
Address _____________________________
City/State/Zip _____________________________
Office Phone ____________________Home Phone _____________________________
Fax ___________________________E-mail _____________________________
Number in your party. _________Name of guest _____________________________
Room reservations must be made directlv with:
Essenhaus Inn, Middlebury, Indiana.
Phone: 574-825-9471
800-455-9471
Fax 574-8285-0455
www.essenhaus.com
To guarantee a room at $89.00 plus tax, reservations must be made
prior to August 24.
*Scholarships for students and
residents to attend FMMF
Consultations.
Please print registration and mail to:
K. David Lefler
12005 Ridgewood Dr.
Fort Ashby, WV 25283