Last Name

Wife's name

Church Name

Church Address

Your Title

Your Email

Church Phone

City State Zip

Please read these important instructions before registering:

1.  If registering for a group, be sure to list ALL names on this form and pay for the appropriate number of guests

2.  You can pay with Paypal (or credit card), by clicking "Pay by Paypal Now"

3.  Or, you can mail in a church check, or pay when you arrive

   This will allow you to pay for the entire group at one time.

Registration Cost - $65 per person  - by January 10th

Late Registration - $70 per person (after January 10th)

You will have the option of paying by Paypal, or you can pay by church check when you arrive.

Upon receipt of your online registration, you will receive an email confirmation with more Conference details.

Pay here by Paypal

Payment Method

Ministry you serve in

Registration Information

to register for the Spanish Conference, click on the Spanish link above

Arrival Flight Info (Date/Time/Airline/Flt #)

If you will be needing airport shuttle transportation to one of the Conference Hotels

we need the following information:

Departure Flight Info (Date/Time/Airline/Flt #)

GROUP INFORMATION

Please list all of the names (first and last) and titles in this box for all those you are registering from your church

Your Cell Phone

First Name

After you submit your online registration, you can go into the PAYPAL site to pay. 

You will need to specify in the "quantity" field how many registrations you are paying for. 

Registration instructions

will be posted

in the Fall

for the

2012 Leadership Conference.