Luther House
211 NW 23rd St.
Corvallis, OR 97330
(541) 753-5213

Please select one option and complete the form accordingly. Once you have completed the form print it and mail it to the address above. Alternatively you can e-mail or call us with the information.
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[1] Name:

[2] Home Address:

[3] City:

[4] State:

[5] ZIP:

[6] Home Phone:

[7] E-mail:

[8] Home Congregation:

[9] Campus Attending:

[10] Address at School: