G od Fi rs t Holy C on voc at ion Wednesday, April 2, 2014 - Saturday, April 5, 2014
R E G I S T R AT I O N F O R M
EARLY BIRD REGISTRATION (ends March 19, 2014): $125.00 (Group Registration of 10 or more Adult Registrations Only - $115.00 per person) REGULAR REGISTRATION (After March, 2014): $150.00
ON-SITE REGISTRATION: $175.00 YOUTH REGISTRATION: $20.00 | YOUNG ADULT REGISTRATION: (Ages 18-30) $75.00 Registration fee includes admission to all Workshops and Convocation Materials.
Registration Type: Clergy_______ Laity________ Youth/Young Adult________ Name_____________________________________________________________________________ Address ___________________________________________________________________________ City ____________________________________ State ________________ Zip _________________ Daytime Phone _____________________________ Evening Phone ___________________________ Email_____________________________________________________________________________ Church____________________________________________________________________________ Presiding Elder District_______________________________________________________________ Annual Conference __________________________________________________________________ Episcopal District or Denomination _____________________________________________________ OPTIONAL WORKSHOP SELECTIONS:
(These workshops are optional and are not required by registrants.)
Workshop Selection: Grant Writing: __________
LOGOS: ___________
Fundraising AM: _________
ADDITIONAL REGISTRANTS: 1-________________________________________________________________________________ Workshop Selection: Grant Writing: __________
LOGOS: ___________
Fundraising AM: _________
2 - _______________________________________________________________________________ Workshop Selection: Grant Writing: __________
LOGOS: ___________
Fundraising AM: _________
3 - _______________________________________________________________________________ Workshop Selection: Grant Writing: __________
LOGOS: ___________
Fundraising AM: _________
Please attach additional paper if more space is needed. General Registration: ______ x $_______ = $__________ (number of Registrants x Conference Fee)
Payment Method: ☐ Check ☐ Money Order/Cashier’s Check Please make payable to: 12th Episcopal District
Youth Registration:
Credit Card: ☐ Visa ☐ Mastercard ☐ American Express
______ x $_______ = $__________
Young Adult Registration: ______ x $_______ = $__________
Card Number
TOTAL ENCLOSED / PAYMENT:
___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
$__________
Expiraton Date: _____/______ _________________________________________________ Cardholder Signature (required for credit card processing) Please mail completed registration form with payment to: 12th Episcopal District, P.O. Box 147, Little Rock, AR 72203 | (501) 375-4310 Office | (501) 375-0306 Fax
or register online at: w w w. 1 2 t h d i s t r i c t a m e . org