Conference Registration Form

PLEASE ALL THAT APPLY:

Full-Time Minister    ERCN Member    Single    Youth

CONTACT INFORMATION

Last Name           First Name

Home Church Name

Mailing Address 

City     State     Zip 

Country  E-mail Address: 

Primary Phone Number      Alternate Phone Number

REGISTRATION FEES (INCLUDES LUNCH)

$60.00 Early Registration (September 20)         $70.00 Registration

Groups of 25 or more (25% Discount)               GWOG Charter Members (20% Discount)

MODE OF PAYMENT

VISA    MasterCard    Discover    American Express

Card Number      Exp. Date     CID 

*please note that child care is only available for the night services.