Register:
All Bold fields are required.
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Starred (*) items will be published in the conference directory
as part of all conference attendee's packets unless
committee is notified not to publish!
Please be sure to SCROLL DOWN and fill in all required areas!
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Login Name
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Password
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Repeat Password
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Title
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Ms.
Mrs.
Miss
Rev
Other:
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First Name*
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Middle Initial*
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Last Name*
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Email*
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Mailing Address*
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Apt # *
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City*
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State*
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Zip/Postal Code*
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Country*
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Home/Primary Phone # *
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Mobile Phone #
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Fax #
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Gender
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Favorite Quote
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Latest News
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Congregation*
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Province*
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District*
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Emergency Contacts
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First Emergency Contact Name
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First Contact Relationship
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First Contact Primary Phone #
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Primary Phone Type
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Home
Work
Cell/Mobile
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First Contact Alt Phone #
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Alt Phone Type
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Home
Work
Cell/Mobile
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Second Emergency Contact Name
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Second Contact Relationship
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Second Contact Primary Phone #
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Second Contact Primary Phone type
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Home
Work
Cell/Mobile
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Second Contact Alt Phone #
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Second Contact Alt Phone type
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Home
Work
Cell/Mobile
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Transportation
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SINGLE DAY Registrations are for local commuters only, no hotel registration.
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Mode of Transportation
to Conference
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Personal vehicle
Airline
Charter bus
Non-charter bus
Church bus
Other
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Special Needs
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Wheelchair
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Handicapped Accessible Room
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Special Diet (be specific)
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Special Diet Needed-
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Day & Workshop Selction
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Click Here to View Workshop Descriptions
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Which Day Are You Attending?
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You MUST Select A Day!
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Morning Workshop
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Afternoon Workshop
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Volunteer Jobs
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Diener Volunteer
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Dieners serve at the Lovefeast Service. We anticipate more volunteers than we can use,
so selections will be made randomly and notification will be made by email.
If you do not have an email address, please indicate your church’s email address on your form.
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Greeter Volunteer
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Greeters will welcome attendees as they arrive at the conference, serve as ushers at our
joint services, and assist with trays for those who may need assistance at meal time.
We anticipate more volunteers than we can use, so selections will be made randomly
and notification will be made by email. If you do not have an email address, please
indicate your church’s email address on your form.
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T-Shirt Orders
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Each T-Shirt is $10 US - total will be added to your conference fee
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QUANTITY
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Small
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Medium
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Large
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X-Large
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XX-Large
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TOTAL # SHIRTS
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Total T-Shirt Cost $
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TOTAL DUE
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$
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This form completes registration;
You will pay later by PayPal or check
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You will receive an email confirming registration and listing your login information.
After logging onto your new account, you will be able to pay via PayPal.
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