Blue

 

2018 "Honey" Conference


REGISTRATION FORM

$25

(all 4 services)

$28 after August 15

 Only one registrant per form please.  Non-refundable, but transferable registration fee
per person
must accompany this registration information.

 

GENERAL INFORMATION:

Position in Church or Organization
Ms/Mrs/Rev/Mr
Name
First Name
Middle
Last Name
Mailing Address
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
E-mail
Re-type E-mail
Cell Telephone
Home Telephone

CHURCH INFORMATION:

Church
Church Mailing Address
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Phone Number
Contact Person: Group Registration
Contact Person: Phone Number
Contact Person: E-mail

CREDIT/DEBIT CARD INFORMATION:

Credit/Debit Card:
Card #
Expiration Date
Security #
Name on Card
Card Holder's Phone Number
Billing Address If Different Than Above
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Comment or Special Instructions:


OFFICE USE ONLY:
File #______________Received____________DD____________Confirmation_____________