First Name
Last Name
Address
Address2
City
State
Zip Code
Phone
Age
Gender
Email Address
Email Address (retype)
Church

 
 (If Not Listed Please Enter Here)
Registration Type
Are you a light sleeper? Yes No
Do you snore? Yes No
 
Volunteer
Would you like to help with music sessions? Yes No
If yes, what instrument(s) do you play?
Would you like to lead a discussion group?

Yes No
Would you like to help coordinate activities? Yes No
 

Transportation
Are you driving? Yes No
If yes, would you be willing to give a ride to others in your area? Yes No
If yes, what is your model/make/plate number?

Would you help coordinate transportation for your church? Yes No
Do you need a ride?

 Yes No
   
   
Comments/Scholarship Requests/Referred By*

*One free registration will be given to the person who refers the most people to register and attend the conference.
 
Workshop Preference #1
Workshop Preference #2
Workshop Preference #3*

*Workshop selected will be given if your others are full