Women
 
Life Conference
 
Online Registration Form

ON-LINE REGISTRATION
Full Name*:
Contact Number*:
No./Street*:
Suburb*:
State/Postcode*:
Date of Birth*:
Church you attend*:
Email Address*:
KIDS LIFE REGISTRATION
Childrens Name & Age:
Friday Night $5/child/session:
Saturday AM $5/child/session:
Saturday PM $5/child/session:
Kids Lunch $8 per child:YesNo
Kids Total $:
PAYMENT DETAILS
My Rego*:
Sponsor a Delegate:
Lunch $10 per delegate*:YesNo
Kids Rego $:
Total Conference Cost*:
I wish to pay by:*:Direct Debit/TransferCashCredit CardCheque
Todays Date*:
Comments or Questions:
Verification:
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