Convention Registration

Convention 2008 Registration

Step 1
	Last Name: *
	First Name: *
	Spouse: (If attending)
	Address: *
	City: *
	State: *
	Zip: *
	Home Phone: *
	Cell Phone:
	Work Phone:
	E-mail: *
	Church or Organization:
	In case of Emergency, Contact:
	Phone:

	Name, Age, and Grade Completed for child(ren) attending:

	Do you have any disabilities that require special accommodation?	Yes No
	Please Describe Specific Needs:

	Additional Notes:

Concurrent Sessions: Indicate the number of people planning to attend each session:
	Friday, 9:30 - 10:30 a.m.	International Ministries:
	Friday, 10:45 - 11:45 a.m.	Church Planting:

Only click the "Continue to Step 2" button once, although a slight delay may occur, you will be
automatically directed to the next step

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260-423-3649

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