The answers you submit will be sent by email to Pastor Eric Vertein, the secretary of the conference. For questions 6-10 "Additional Attendee," please designate whether they are Pastors, Teachers, or Lay Members. If you will be the secretary/reporter for your circuit, please indicate that by including (Rep) in the "role" question. I'm asking for your email, too, so that I can let you know if I've received your registration. Thank you for your prompt registration!

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1. Name (First, Last)
2. Your Church
3. City (where your church is located)
4. Your Role (Pastor, Teacher, Lay Member)
5. Number Attending from Your Church Including You (if you know)
6. Name of Additional Attendee (and role)
7. Name of Additional Attendee (and role)
8. Name of Additional Attendee (and role)
9. Name of Additional Attendee (and role)
10. Name of Additional Attendee (and role)
Your E-mail Address