REGISTRATION:
$20 NON-REFUNDABLE FEE THROUGH OCTOBER 13. Limited scholarships available. Check the scholarship box below.
Name: ___________________________________ Age: ______ Gender: ______
Marital Status: __ single/never married; __ single/divorced __ married; __ divorced/remarried;
Address: _________________________ City: ________________ State: ____ Zip: ______
Phone Number: ( ) _____________Email: ________________
Church/Address: ___________________________________________________
How did you hear about this conference? ______________________________
Occupation (if student, are you undergraduate or graduate): _____________
___ First time attending ___ Attended before, how many years? ____
To assist with accommodations, please list the number of the workshops you plan to attend.
I plan to attend the following AM Workshop: ___ PM Workshop: ___
___ $20 for registrations postmarked by OCTOBER 13th
___ $30 for late registration after OCTOBER 13th or at the door
___ Additional $30 for Continuing Education Units.
___ $10 for students
___ TOTAL amount enclosed
Easy to Register: