Form

Home Address*

E-mail*
Church Information
Name of Your Church*
Church City and State
Church offices you currently hold
Seminar Pre-Registration Information
I am registering for:*

Pre-Seminar Friday, Nov. 5 (Cost $35) - cost increases to $40 after Oct. 14 Main Seminar Saturday, Nov. 6 (Cost $35) - cost increases to $40 after Oct. 14 BOTH Friday and Saturday (Cost $55) - cost increases to $70 after Oct. 14
I will attend the following track.*
Your Payment Option of Choice
Mark this box if it is true of you.

I am currently a pastor at my church.

Please use this selection to let us know how you will pay for the seminar. Please make checks payable to Biblical Counseling Ministries and mail or deliver them to Calvary Baptist Church 469 Airport Avenue Wisconsin Rapids, WI 54494. Registration is not complete until payment is received.
Payment Choice

I will mail or deliver my $40 registration for the Fri. OR Sat. session to Calvary Baptist Church of Wisconsin Rapids. I will mail or deliver my $70 registration for the Fri. AND Sat. sessions to Calvary Baptist Church of Wisconsin Rapids. I would like to pay for the Fri. OR Sat. session with my credit card or PayPal account. The cost for this option is $42. I would like to pay for the Fri. AND Sat. sessions with my credit card or PayPal account. The cost for this option is $72.50.

2010 BCM Seminar Registration