AIM Convention Registration Form

Event Date: June 16th - 19th , 2026

Event Time: 7:30 PM

Event Address: Christian Worship Center COGIC

1414 West Main Street Leesburg, FL 34748

Your Name

PrefixFirst NameLast Name

Email Address

example@example.com

Contact Number

Please enter a valid phone number.Format: (000) 000-0000.

Will you have a guest with you?

District

Guest Name

PrefixFirst NameLast Name

Guest Name

PrefixFirst NameLast Name

Guest Name

PrefixFirst NameLast Name

Guest Name

PrefixFirst NameLast Name

Would you like to be updated about the upcoming events?

Please enter the age of each young adult

Please enter the age of each child

Church Name for Report

My Products

Adult Registration

$50.00 Quantity

Young Adults (Ages 12-21)

Please enter the age of each young adult at the bottom

$30.00 Quantity

Children (Ages 5-11)

Please enter the age of each child at the bottom

$10.00 Quantity

AIM Church Report

Small Church

$165.00 Quantity

AIM Church Report

Medium Church

$200.00 Quantity

AIM Church Report

Large Church

$220.00 Quantity

Total

Payment Cash App Payment Instructions: Send your payment to: $CWCCOGIC3. Include your name in the Notes. After sending, upload a screenshot below to confirm your order.

Credit Card

Apple Pay

Google Pay

Cash App Pay

How would you like to pay?

AIM Convention Registration Form

Event Information

Attendee Information

My Products

Payment Cash App Payment Instructions: Send your payment to: $CWCCOGIC3. Include your name in the Notes. After sending, upload a screenshot below to confirm your order.