Church Conference Registration Form


Personal Information


First Name

Middle Name

Last Name


Preferred Bagde Name


Street Address

City

State/Province

Postal/Zip Code


Phone Number

Email Address


Age


Emergency Contact Information


First Name

Last Name


Phone Number

Relationship


Registration Type


Meal Preferences


Special Needs/Accommodations


Please let us know if you require any special accommodations (e.g., wheelchair access, sign language interpreter, dietary restrictions.)


Church Affiliation


How did you hear about this conference?


Registration Fee

Amount

$50.00

Payment Method


Agreement/Release


I understand that by registering for this conference, I agree to release [Church Name] and its staff from any liability for injury or loss that may occur during the conference. I also grant permission for [Church Name] to use photographs or videos of me taken during the conference for promotional purposes.


Signature


Item total$50.00
Total$50.00
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