Advance Registration

94.00 per person
--lunch included--

Registration Information

Name

Church

Address

City

State

Zip 

E-mail

(eg. example@mymail.com)

Telephone

Ministry Title

Please list the names of EACH person registering on this form.

Credit Card Information

Card Type

Master Card     Visa     American Express     Discover

Card Number

Exp. Date /

Name on Card

Security Code

3 digit number on back of card

Billing Address

Cost

I approve the 94.00 advance registration fee per person

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