1.
Name:
2.
Mailing Address:
3.
Email Address:
4.
Organization/Mission Affiliation:
5.
Current Position:
6.
Phone:
7.
Fax:
8.
Ministry Website Address:
9.
Write a brief Bio about your ministry focus:
10.
Do you want to register for the Pre-Conference, April 4 & 5? Additional Pre-Conference cost is $55.
11.
Do you need housing before or after the conference?
12.
Roommate Preference:
13.
Comments or Concerns: