Form

TAKE OVER CONFERENCE 09 REGISTRATION FORM
Payment Options *	Full Registration ($40.00) A La Carte (Non-Registrants) Luncheon Only ($15.00) T-Shirt ($10.00) Total : $0
First Name *
Last Name *
Address *
City *
State *
E-mail *
Phone Number *
Church Name
Church City & State
Pastor Name
T-Shirt Size *