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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:
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 Lunch $8 per child:
Yes
No
Kids Total $:
PAYMENT DETAILS
My Rego
*
:
Adult $65 (1st Sept - 31st Dec 08)
Concession $55 (1st Sept - 31st Dec 08)
Sponsor a Delegate:
Adult $65 (1st Sept - 31st Dec 08)
Concession $55 (1st Sept - 31st Dec 08)
Lunch $10 per delegate
*
:
Yes
No
Kids Rego $:
Total Conference Cost
*
:
I wish to pay by:
*
:
Direct Debit/Transfer
Cash
Credit Card
Cheque
Todays Date
*
:
Comments or Questions:
Verification:
Banner photos courtesy of Andrew Arkapaw, Sasha Crofts and Cindy Ross
