Registration type : Please selectcoupleindividualfamily

Number of adults participating in the conference

Number of children participating in the conference

First Name of Participant

Last Name of Participant

Your Mobile phone number

Your Home phone number

Your Email

Which church do you attend regularly?

[group group-spouse clear_on_hide]
Spouse Information
First name of Participating Spouse

Last name of Participating Spouse

Your Spouse's Mobile phone number

Your Spouse's Email

[/group]

[group group-children clear_on_hide]
Children Information: Name and Date of Birth

[group group-child1 clear_on_hide]

[/group]

[group group-child2 clear_on_hide]

[/group]

[group group-child3 clear_on_hide]

[/group]

[group group-child4 clear_on_hide]

[/group]

[/group]

[calculate_button "Calculate Amount"]
Amount
$

Preferred Method of Payment:Please selectCashCheckPayPal

Pay Amount Now

If your preferred method of payment is PayPal, Please remember to come back here to SEND the form.