Church Relations Conference Registration Form

Basic Information

First Name Middle Name Last Name Mailing Address City State/Prov ZIP/Postal Code Country Email Phone

Church Information

Church Name Church Position

Events

Youth Pastors & Parents Conference with Dr. Walt Mueller, October 20, 2010

Please select which workshops you would like to attend:

Workshop session I (11:15–12:15)

Marv Penner – “Losing My Religion” Derek Melleby – “Making College Count – Preparing Students for the College Transition”

Workshop session II (1:45–2:45)

Walt Mueller – “The Changing Family and Implications for Ministry” Marv Penner – “The Spiritual Nurture of Teens” Derek Melleby – “Making College Count – Preparing Students for the College Transition”

All registrations through October 15: $45 per person.

After October 11: Single registration: $55. Two or more from same church: $45 per person.

Number of attendees: × $ = $

Please enter names and positions of all attendees (excluding yourself).

Total

$ for Youth Pastors & Parents Conference registration

Click Submit to record your registration and view payment options.

Please click only once!