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Registration Form |
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Please print this form using your
web browser's print function. After you fill out the form,
please mail it with your payment
to:
Alpha North America Conference
Registration
5500 West 91st Street
Overland Park, KS 66207
Registrations with credit card payment can be faxed toll-free
to 866-329-8687.
If you have questions, call toll-free 866-872-5742 or
email alphaconferences@aol.com
Note: Except
for spouses, each delegate requires a separate registration
form. Payment can be tallied on the lead form.
Back to the
Registration Main Page
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Philadelphia
2002 Alpha Conference
May 30-31st, 2002
__Mr. __Mrs. __Miss __Ms __Dr. __ The Rev. __Pastor __Other_____________________
First Name: _________________ Last Name: ___________________________________
Spouse's Name (only if spouse is attending): ____________________________________
Mailing Address (indicate home church)
Address: ________________________________________________________________
City: ___________________________________ State: ____
Zip Code: ________-_____
Email Address: ___________________________________________________________
Daytime Phone: ____________________ Evening Phone: _________________________
Fax: ________________________ Denomination: _______________________________
Church/Ministry Name: _____________________________________________________
Church City, State, Zip: _____________________________________________________
___ We are a Partnering church.
___ I am currently running an Alpha course.
___ This will be my first time attending an Alpha
conference.
___ I have attended (a) previous Alpha conference(s).
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Payment
Information: |
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____
(no. of delegates)
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X
$99 |
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$___________ |
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(no. of delegate/spouse couples) |
X
$148 |
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$___________
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(no. of delegates at group rate) |
X
$89 |
=
$___________ |
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(no. of student/partner delegates) |
X
$49 |
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$___________ |
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____ (no. of late fees: 2 weeks prior) |
X $20 |
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$___________ |
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Total
Payment |
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$___________ |
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___ Enclosed is a check for $_________
(Payable to Alpha North America), or
___ Please charge my __Visa __MasterCard __American Express
__Discover Credit Card
Number:_______________________________ Expiration Date:
____________________
Name as appears on card:__________________________________________________
Daytime Phone: _______________________ Evening Phone:
______________________
Billing Address: ___________________________________________________________
Billing City, State, Zip: ______________________________________________________
Signature:_____________________________________ Date:
_____________________
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Registration Main Page |
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