Registration Form

Conference Registration Cost: $125

Registration Includes:

• Continental breakfast
• 2 General Sessions
• 2 class sessions of your choice
• Lunch
• All conference materials

Important Information:

• There is a non-refundable, minimum deposit of $25 required for registration
• $125 registration fee must be paid in full on/before July 25, 2010.
• Registration deposit must be included with completed Registration Form.
• No on-site registration.  No registration accepted after July 25, 2010.
• Registration dates, deadlines & Cancellation Policy strictly enforced.

Cancellation Policy  

If, for any reason you must cancel, a written cancellation must be provided and all monies paid, minus the $25 non-refundable deposit will be returned to you within two weeks of receiving your cancellation request. No refunds after July 25, 2010.

Personal Information
First Name
Last Name
Street Address
City
State	--AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
Zip Code
Email Address
Home Phone
Cell Phone
Church Membership	Antioch Missionary Baptist Church  None Other
Emergency Contact
Name
Phone
Medical Needs (if any)
Class Sessions (choose two)
First Class	Great Is Thy Faithfulness Whose Report Will You Believe? The Boomerang Effect of Forgiveness Blessed and Broken In Due Season
Second Class	Great Is Thy Faithfulness Whose Report Will You Believe? The Boomerang Effect of Forgiveness Blessed and Broken In Due Season
Password	This allows you to sign in to make additional payments and to update your name and address.
Create New Password
Confirm Password
	I have read and I accept the Cancellation Policy