2018 Men's Conference Registration
Name
*
First Name
Last Name
E-mail
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Discipleship Community
*
Amazing Grace
New Life #2
Sonrise
Abundant Life
Cornerstone
Cross Connection
CrossTrainers
Epoch
Koinonia
New Life #1
ShareLife
Vineyard
The WALK
The Anchor
Crux
Full Armor
Fusion
Growing in Grace
Learning the Word
Legacy Builders
LifeSpring
The Orchard
Do Not Attend
Age
*
18-25
26-35
36-45
46-55
56-65
66 and older
Emergency Contact - Name
*
First Name
Last Name
Emergency Contact - Phone
*
-
Area Code
Phone Number
Roommate Request
First Name
Last Name
Special Dietary Request(s)?
We cannot guarantee that the Cove can meet your dietary needs. However, they will try to accommodate to the best of their ability. If you have dietary requests, you will be contacted before the conference to help make arrangements.
Payment Type
*
Credit Card
Cash
Payment (check all that apply)
*
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Deposit Only
$100.00
$
100.00
Complete Registration (includes Deposit)
$270.00
$
270.00
Total
$0.00
$
0.00
Register
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