Name*
Street Address*
Address (cont.)
City*
State*
Zip*
Work Phone
Home Phone*
E-mail*
The name and address of your church: Are you a member? Yes No Your pastor's name: Denominational affiliation:
You do not have to be a member of a church to attend a seminar. These questions are for statistical purposes only.
Statement of Faith: Do you agree with this statement? "It is my personal confession that Jesus Christ came in the flesh and that Jesus is Lord." Yes No
X _____________________________________ Sign here to acknowledge your answer to the above question.
Registrations will not be confirmed until paid in full.
Seating is limited to 20. (Minimum of 10.) No on site registration.
$249 per person
Total Enclosed (check or money order):
Print 2 copies of this registration form. Mail one signed copy with your payment to: Heart Communications P.O. Box 232251, Centreville, Virginia 20120 USA
or Complete Registration ONLINE ...
Do Not Make Any Travel Bookings Until Minimum # of Participants is Confirmed For The Session You Are Registering For
