|
Conference Registration Form: please print page, fill out and
mail to address at bottom. If possible, please provide an email
address for acknowledgement of your registration.
|
Name
______________________________________________________________________________________
Street Address
_______________________________________________________________________________
City _____________________________________________ State
______________ Zip ___________________
Phone ______________________________ Email
__________________________________________________
Conference registration prices below are valid if
payment received by Oct. 10th.
|
|
Number |
|
Subtotals |
|
_____ |
Conference Registration, Individual ($10) |
_____ |
|
_____ |
Conference Registration, Family
($25) |
_____ |
|
_____ |
Church
Pastor
(Free!) Your church? __________________________________ |
_____ |
|
_____ |
Lunch, Individual ($5) |
_____ |
|
_____ |
Dinner, Individual ($10) |
_____ |
|
_____ |
Dinner, Child under 8 ($5) |
_____ |
|
_____ |
Dinner, Family ($25) |
_____ |
|
_____ |
Child Care ($1 / Child)
- List Ages: ___________________________________ |
_____ |
|
_____ |
Donation towards conference expenses |
_____ |
| |
Total |
_______ |
Method of Payment:
____ Check ____
Credit Card
Amount Charged ________
Credit Card Type and Number:
________________________________________________________________________
Name on Card:
____________________________________________________________________________________
Exp. Date: _________________
CCV Code: _________ Billing Zip Code:
_______________
If you have any questions, please call (360)
574-1569. Make checks payable to “United for Life Conference”
and mail with this form to: United for Life Conference,
PO Box 822734,
Vancouver, WA 98682 |
