Today's Date

Your Name

Your Email Address: 

Who will be the contact for this registration?       I Am the Contact I am not the contact

Contact's name other than you - NONE Pastor Mr. Mrs. Ms.

Contact's Email Address: 

Name and Email of Each Person in Your Party

NAME(S) OF THOSE REGISTERING WITH YOU (INCLUDING YOUR NAME):

(For every 5 persons from your church registered, one person may attend for FREE.)

1.  Pastor Mr. Mrs. Ms.     
                    

2.  Pastor Mr. Mrs. Ms.     
                      Email:         

3.  Pastor Mr. Mrs. Ms.     
                      Email:         

4.  Pastor Mr. Mrs. Ms.     
                       Email:         

5.  Pastor Mr. Mrs. Ms.     
                      Email:         

6.  Pastor Mr. Mrs. Ms.     
                      Email:         

7.  Pastor Mr. Mrs. Ms.     
                      Email:         

8.  Pastor Mr. Mrs. Ms.     
                      Email:         

9.  Pastor Mr. Mrs. Ms.     
                      Email:         

10. Pastor Mr. Mrs. Ms.     
                      Email:         

11. Pastor Mr. Mrs. Ms.     
                      Email:         

0 1 2 3 4 5 6 7 8 9 10     x  $55 per person if registering after June 15, 2009.       TOTAL AMOUNT DUE   NONE $55.00 $110.00 $165.00 $220.00 $275.00 $330.00 $385.00 $440.00 $495.00

0 1 2 3 4 5 6 7 8 9 10   of  FREE REGISTRANTS for every (5) paid.                   TOTAL ATTENDING IN THIS GROUP 0 1 2 3 4 5 6 7 8 9 10

Name on this card