Name (Individual or Contact Name for Group Registration):

Address: Address 2:  

City: State: AK AZ AL AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code: Phone:  

Email:

Name of Church (If Affiliated):  

Church Address: City: State: AK AZ AL AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code:

Pastor's Name: Church Phone:

If Group Registration, Please include a list of all the names you are registering for the conference and or Concert only (Full Names – Please Specify Adult or Young Person)

Please Note:  To avoid getting counted twice, do not include anyone staying in the hotel in this group.

What is your method of payment? Cash Credit Card/Debit Card Cashiers Check/MoneyOrder

Register By November 1st, 2010