Register for the 2011 National Leadership Conference

Held on 18th August - registrations close 3rd August

Please submit this form for EACH participant registering.

REGISTRATION FORM
Name:
Postal Address:
Phone:	Home:    and/or   Mobile:
Email address:
Registration Type:	Early Bird ($65 if received by 17th July)   Full ($75 after 17th July)
Registration Total:	$    whole dollars only
Payment Method: payment options available	-- Select proposed payment method -- Cheque Money Order Electronic payment to bank account Cash in person to Church Office
Your home church: (if any)
Enter Verification Code:	(case sensitive)