application

REGISTRATION FORM

FULL NAME

STREET ADDRESS:

COUNTRY:

HOME PHONE/AREA CODE:

WORK PHONE/AREA CODE:

FAX NO:

E-MAIL ADDRESS:

CHURCH NAME:

SENIOR PASTOR:

CHURCH ADDRESS:

I WOULD LIKE TO BE A DELEGATE FROM THE NATION OF:

I AM COMING AS AN INDIVIDUAL:

I AM WITH A GROUP OF:

I PRESENTLY RESIDE IN THE COUNTRY:

MY DENOMINATIONAL AFFILIATION:

ENGLISH SPEAKING YES/NO OTHER LANGUAGES

I WOULD BE ABLE TO HELP WITH TRANSLATION IN

ENCLOSED IS MY REGISTRATION FEE OF

Credit Card Type

Credit Card No.

Expires:

Todays Date:

SIGNATURE:

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