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Number Attending ON CAMPUS:

Number Attending OFF CAMPUS:

Number Attending Registration ONLY:

Title / Position

First & Last Name

Phone Number

Address

Church Name

Church Address

Church Phone Number

Email Address

Dietary Restriction

Terms & Agreement

I agree to the following documents. I have read and fully understand this Conference Registration, Waiver, and Release of Liability Form and agree to be bound by its terms. I/We understand that by signing this document I/We are waiving certain legal rights for the Participant and us, including the right to sue the Release Parties. I/We sign this document on behalf of the Participant and us freely and willingly.