2009 Educational Congress Registration

Category A

$150.00- 25 Delegates Maximum
Additional Delegates - $10.00 Each

Category B

$300.00 - 50 Delegates Maximum
Additional Delegates - $10.00 Each

Category C

$450.00 - Unlimited Delegates

Category D

$50.00 - 50 Delegates or Less, 10 Messengers Max.
Additional Delegates above 10 - $10.00 Each

Category E

Individual Registration - $20.00

Category:

Delegate 1

First Name: Last Name:
Course Number/Name

Delegate 2

First Name: Last Name:
Course Number/Name

Delegate 3

First Name: Last Name:
Course Number/Name

Delegate 4

First Name: Last Name:
Course Number/Name

Delegate 5

First Name: Last Name:
Course Number/Name

Delegate 6

First Name: Last Name:
Course Number/Name

Delegate 7

First Name: Last Name:
Course Number/Name

Delegate 8

First Name: Last Name:
Course Number/Name

Delegate 9

First Name: Last Name:
Course Number/Name

Delegate 10

First Name: Last Name:
Course Number/Name

Churh Name:

Church Address:
City:
State:
Zip:

Your Contact Information

First Name:

Last Name:

E-mail: