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Online Registration
2010 Online Registration Form
ON-LINE REGISTRATION
Full Name
*
:
Contact Number
*
:
No./Street
*
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Suburb
*
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State/Postcode
*
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Date of Birth
*
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Church you attend
*
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Email Address
*
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KIDS LIFE REGISTRATION - Please Note: Kids rego's close on 23rd August
Kids Names & Ages - any Allergies:
Friday Night $5/child/session:
0
1
2
3
4
5
6
Saturday AM $5/child/session:
0
1
2
3
4
5
6
Saturday PM $5/child/session:
0
1
2
3
4
5
6
Kids Total $:
PAYMENT DETAILS - Please Note: Full payment needs to be received within the bracketed dates to be eligible for specified offer
My Rego
*
:
$95 ADULT Rego (18th august 2010 – 27th august 2010)
$85 CONCESSION Rego (18th august 2010 – 27th august 2010)
Workshop Registration
*
:
Pick 1 of the following:
Your calling to rise
Being the light to your world & the next generation
Conquering fear
Spiritual health and growth
Relationships; grandmother, mother, sister,
Time management and organisation
Women in business and management
I would like to sponsor delegate/s
*
:
No thank you
YES - please contact me for their details
Kids Rego $:
Total Conference Cost
*
:
I wish to pay by:
*
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Direct Debit/Transfer
Cash
Credit Card
Cheque
Conference Paid - registering for workshop/Lunch Order/Childcare Booking Only
Todays Date
*
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Comments or Questions:
Verification:
Banner photos courtesy of Andrew Arkapaw, Sasha Crofts and Cindy Ross
