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Registration Form


Conference Costs
  • Early Bird Registration:  $450 (Minimum $100 deposit required at time of registration)
    • Fee applies to those registering:  December 5, 2010 – May 30, 2011
    • Balance due on/before July 31, 2011
  • Pre-Registration:  $475 (Minimum $125 deposit required at time of registration)
    • Fee applies to those registering:  April 25, 2011 – June 26, 2011
    • Balance due on/before July 31, 2011
  • Registration:  $500 (Minimum $150 deposit required at time of registration)
    • Fee applies to those registering:  June 27, 2011 – July 31, 2011
    • Balance due on/before July 31, 2011
  • Include double occupancy hotel for two (2) nights, meals (lunch on Friday on your own), and all retreat materials.
  • Are assessed upon receipt of non-refundable Registration Fee.
  • Must be paid in full on/before July 31, 2011.
  • Registration Fee must be included with completed Registration Form.
  • Registration dates, deadlines & Cancellation Policy strictly enforced.
Cancellation Policy  
If you must cancel for any reason a written cancellation must be provided and the following cancellation fees apply and will be strictly enforced.  (Conference payments are nontransferable.)

Cancel December 6, 2010 – April 24, 2011 $50 cancellation fee
Cancel April 25, 2011 – June 26, 2011 $100 cancellation fee
Cancel June 27, 2011 - July 31, 2011 $150 cancellation fee
No refunds after July 31, 2011  


Personal Information  
First Name
Last Name
Street Address
 
City
State
Zip Code
Email Address
Home Phone
Cell Phone
Birth Date   
Roommate
Church Membership Antioch Missionary Baptist Church 
None
Other    
Emergency Contact  
Name
Phone
Workshops
Choose One for Each Session
 
Session 1 Friday, August 19  -  9:00 AM - 10:20 AM
Enter the Throne Room
Flying Solo
Why Can't We Be Friends?
Hearing God and Having the Guts to Respond

Session 2 Friday, August 19  -  10:30 AM - 11:50 AM
Enter the Throne Room
Flying Solo
Moving Forward
God's Amazing Grace

Session 3 Friday, August 19  -  12:00 PM - 1:20 PM
Why Can't We Be Friends?
Moving Forward
God's Amazing Grace
Hearing God and Having the Guts to Respond

Optional Payment Plans Please review the optional registration payment plans below, and choose the one you want.
Plan I
  • Pay $100 on/before 12.31.2010
  • Pay $50 on/before 01.31.2011
  • Pay $50 on/before 02.28.2011
  • Pay $50 on/before 03.31.2011
  • Pay $50 on/before 04.30.2011
  • Pay $50 on/before 05.31.2011
  • Pay $50 on/before 06.30.2011
  • Pay $50 on/before 07.31.2011 -  Paid in Full
Plan II
  • Pay $150 on/before 04.24.2011
  • Pay $150 on/before 06.26.2011
  • Pay $150 on/before 07.31.2011 -  Paid in Full
Plan III
  • Pay $100 on/before 04.24.2011
  • Pay $125 on/before 05.29.2011
  • Pay $125 on/before 06.26.2011
  • Pay $100 on/before 07.31.2011 -  Paid in Full
Plan IV
  • Pay $450 on/before 04.24.2011  -  Paid in Full

Special Banquet Meal Request  
Specify your special request, if any


 
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  I have read and I accept the Cancellation Policy
 

 
2011 Conference Information
 • Conference General Theme
 • Message from the Director
 • General Session Speakers & Guests
 • Workshop Speakers
 • Optional Sessions
 • Book Recommendations
 • Registration Information
 • Register Online Now!
 • Download Registration Form
 • Conference Highlights
 • Oakbrook Marriott Hotel
 • Important Information
 • Make a Conference Payment
Iron Sharpens Iron

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