Registration Form

Complete this registration form and forward it to P.R.A.Y. to receive the following services:
• Startup kit (including color posters and brochures);
• RRI Team updates and news bulletins;
• Free subscription to Youthscope (P.R.A.Y.’s quarterly newsletter)

Council name______________________________________________________
Address__________________________________________________________
City, State, Zip _____________________________________________________
Phone____________________________________________________________
Fax______________________________________________________________
Web page_________________________________________________________
Name of council support person ________________________________________
Phone____________________________________________________________
Email_____________________________________________________________

RRI Team members:

Name _________________________  Name  _________________________ 
Address _______________________  Address_______________________
City, State, Zip __________________ City, State, Zip __________________
Phone  ________________________ Phone  ________________________
Fax ___________________________ Fax ___________________________
Email _________________________  Email _________________________ 
 

 
Name _________________________  Name  _________________________ 
Address _______________________  Address_______________________
City, State, Zip __________________ City, State, Zip __________________
Phone  ________________________ Phone  ________________________
Fax ___________________________ Fax ___________________________
Email _________________________  Email _________________________ 
 

 
Name _________________________  Name  _________________________ 
Address _______________________  Address_______________________
City, State, Zip __________________ City, State, Zip __________________
Phone  ________________________ Phone  ________________________
Fax ___________________________ Fax ___________________________
Email _________________________  Email _________________________ 

Add additonal pages as needed.
Send Form to: P.R.A.Y. 8520 Mackenzie Rd, Ste. 3, St. Louis, MO 63123-3413 or Fax to 314-638-7250

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