Check all that apply.	Rev. Mr. Ms.	Dr. Mrs. Miss.
Name
Reply E-mail Address
Seminar Location	Please Select March 4 – 6, 2004 - Stamford, CT March 11 – 13, 2004 - Orlando, FL April 15 – 17, 2004 - Memphis, TN May 20 – 20, 2004 - Charlotte, NC May 27 – 29, 2004 - Harrisburg, PA June 17 – 19, 2004 - Dallas, TX July 8 – 10, 2004 - Chicago, IL July 29 – 31, 2004 - Atlanta, GA August 19 – 21, 2004 - Houston, TX August 26 - 28, 2004 - Columbus, OH September 9 – 11, 2004 - Denver, CO September 23 – 25, 2004 - Greenville, SC
Church Name
Church Address
Church City/State/ZIP
Church Phone
Home Address
Home City/State/ZIP
Daytime Phone
Preferred Mailing Address	Home	Church
Accommodations Desired	Single	Double
If Double, Roommate’s Name
Is he/she participating in training?	Yes	No
Dietary Restrictions
Other Needs
Additional Information
Is this registration for	NEW ENROLLMENT: Includes training for one person, room, meals, leader's resources and CHRISTIAN BELIEVER materials for the first group of twelve plus a leader. ADDITIONAL PERSON: Includes training for one person, meals, leader’s resources.  Additional group resources should be ordered separately.

   

The Church account will be billed after the seminar. Six-month installment terms are available.

CANCELLATION CLAUSE: Failure to give notice of cancellation prior to the event will result in a $25 charge.

 
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