Date of Registration
Registration amounts: $35.00 adults and $15.00 Young ladies 12-17 yrs.
Non-refundable registration fee amount paid:
Young Lady 12-17
Amount
T-shirt Size (Indicate Size and Number)
Adult age 18+
Amount
2XL
L
XL
3XL
S
M
Registration Includes; All conference sessions, Conference Materials,
T-Shirt, Conference Tote, Friday and Saturday meals.
Last Name
First Name
Street
Address
City
State
Zip Code
Phone
Number
Email
Church
Name
Pastor
How did you learn about the conference:
*We the undersigned understand that all information presented or discussed during the duration of
this conference “Phenomenal Woman of God” is confidential and is: 1.
Not to be discussed at anytime with anyone not present during this conference or not assigned
specific service responsibilities by the committee. 2. Not discussing any information pertaining to
any participant in any place where it can be overheard by anyone not directly involved with the
group. 3. I will not release any information, in writing or orally, regarding any participant to any
person(s) or agencies. I understand that in extreme circumstances, such as medical emergencies, it
may be necessary to release information to a heath care giver without the group members consent.
The undersigned has had the opportunity to fully participate and offer opinions and input in the
proceedings of the conference and understand the guidelines and responsibilities assigned to them.
I have read and agree to the above
Date
Electronic Signature
Pay Registration Fee