C.S.I. Congregation of Hudson Valley
(United Church of Christ)
101 Pondfield Road West
Bronxville, NY 10708

 

“All Praises Due” Registration Form – Part 1

 

Please fill in all information. Both applicant and Vicar-in-charge have to sign below, unless Vicar is the applicant as well, in which case only sign once in the Vicar Signature field.  This is Part 1 of the registration form.  Part 2 will be completed during inter-church visits.  Completed forms can be mailed to:                                                                                     

Rev. Jacob Chacko
332 East Grassy Sprain Road
Yonkers, NY 10701

or faxed to:  (914) 376-9353

Church Name:  
Vicar:  
Total Number of Programs:  
Estimated Number of Participants (youth):  
Estimated Total Number of People attending from your church (excluding participants) over 4 yrs old:  

  

Youth Vice-President

Phone Number

E-mail Address

 

 

 

 

Youth Secretary

Phone Number

E-mail Address

 

 

 

 

Church Secretary

Phone Number

E-mail Address

 

 

 

   

.................................................................    ..................................
Signature of applicant (if other than Vicar)  Date

 

 
.................................................................    ..................................
Signature of Vicar   Date

 

 

Questions?  Contact:

President:
Rev. Jacob Chacko    
(914) 771-9803 
achen@csihudsonvalley.org		 Talent Show Coordinator
Abey G. Mathew
(914) 375-2430
romeoab@hotmail.com