Converge KC
JUNE 4-6
Minister & Leadership Conference 2012

Registration
 
Please fill out ALL the information below to the best of your ability.
Each attendee must register. All attendees are responsible for their
own hotel rooms. To receive the special rate rooms must be booked
prior to 5/18/2012. Each attendee must be contacted to confirm their registration.
Make sure all information entered is correct!
ALL ATTENDING MUST REGISTER INDIVIDUALLY!
- Your Information -
First Name
Last Name
Address
City
ST
Zip
Phone
Fax
EMail
Title
Number in Party:  
- Church Information -
Church
Church Address
City
ST
Zip
Phone
Fax
Church Email
Church Web Site

Special Instructions:

Please put me on your mailing list:

Please contact me as soon as possible regarding this matter.