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2010 Family Worship Conference Registration
Theme: Family the Way God Intended
Conference Fees: Adults $10.00    Youth: $5.00 (Ages 5-18)

Adult Name

Male Female
Adult Name

Male Female
Adult Name

Male Female
Home Telephone
Email Address
Street Address
City
State (i.e. GA)
Zip Code
List the names of your children attending the conference
Name Age
Name Age
Name Age
Name Age
Total number of participants in your group Adults Kids
Dinner will be served on October 15th
Continental Breakfast served on October 16th
Will you join us for dinner? Yes No    How Many?
Will you join us for breakfast? Yes No    How Many?
Authorized Signature