| Registration
Form: |
The red asterisk (*)
indicates required fields. |
|
*
First Name:
|
|
Middle Initial: |
|
|
* Last
Name :
|
|
|
* Title/Position:
|
|
|
*
Church/Organization/Affiiliation :
|
|
|
* Church/Affiliation
Address:
|
|
City: |
|
State:
|
Zip:
|
|
*
Home Address:
|
|
City: |
|
State:
|
Zip:
|
| Please send all correspondence to (check
one): |
|
Church/Affiliation Address |
Home Address |
|
*Email:
|
|
|
*
Day Phone Number:
|
Ext
|
Evening Phone Number: |
|
Cell Phone Number: |
|
Also
if you would like to help and participate in this
great event through Praise Dancing, Choir, Preaching,
Praise Team, Praise steppers or good old fashion witnessing.
Please let us know. |
|
|
T-Shirt, Size Small
....$10.00 Quantity
|
T-Shirt, Size 2X Large $10.00
Quantity
|
|
T-Shirt, Size Medium $10.00
Quantity
|
T-Shirt, Size 3X Large $10.00
Quantity
|
|
T-Shirt, Size Large....
$10.00 Quantity
|
All sizes over 4X should
be noted. Prices $15.00 |
|
T-Shirt, Size X Large $10.00
Quantity
|
Hats available upon request.
Price $7.00 |
| |
|
| Electronic Checks - |
Please fill out the following: |
| Checking Acct. Number:
|
|
| Checking
Routing Number:
|
|
| For Major Credit Cards - |
Please fill out the following: |
| Select the card: |
|
| Credit Card Number: |
|
| 3 Digit CVV (on
back of card)
|
Visa or Mastercard
American Express
|
| Expiration Date: |
|
| |
|
