CEEC 2021 Synod Registration Form

Full Name *

Prefix First Name Last Name

Name Badge

Preferred Name For Name Badge

Jurisdiction

Name of Archdiocese, Diocese, Apostolate, etc.

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Present E-mail *

myname@example.com

Mobile Number

Country Code Area Code Phone Number

Registration Type *

Registration INCLUDES Hotel and Meals

INTERNAL REG TYPE

ROOM TYPE

BED ONE

BED TWO

BED THREE

BED FOUR

Spouse

Prefix First Name Last Name

Spouse Name Badge

Preferred Name For Name Badge

Church Delegate 1

Prefix First Name Last Name

Delegate 1 Name Badge

Preferred Name For Name Badge

Church Delegate 2

Prefix First Name Last Name

Delegate 2 Name Badge

Preferred Name For Name Badge

Church Delegate 3

Prefix First Name Last Name

Delegate 3 Name Badge

Preferred Name For Name Badge

First time to attend a CEEC conference? *

Yes No

Do you want a CEEC.CHURCH email address?

CEEC.CHURCH emails are free to CEEC clergy.

Do you have any mobility restrictions?

If so, please describe them

Due to personal financial constraints, I wish to request

Split Registration Fee (4 payments) Travel Assistance Synod Registration Assistance

Total Fees Due

Pay Fees By

Select Payment Method

FOR PAYMENTS BY CHECK:

Make your check payable to "Continuing Evangelical Episcopal Communion" and mail to -

Continuing Evangelical Episcopal Communion
ATTN: 2021 SYNOD
124 Bedstone Drive
Saint Johns FL 32259

FOR PAYMENTS BY TRAVELERS CHECKS:

Make certain your travelers check is payable to "Continuing Evangelical Episcopal Communion" and has been signed in BOTH locations required. Do not send BLANK travelers checks. Mail to -

Continuing Evangelical Episcopal Communion
ATTN: 2021 SYNOD
124 Bedstone Drive
Saint Johns FL 32259

FOR PAYMENTS BY MONEY ORDER:

Make certain your money order is payable in US Dollars to "Continuing Evangelical Episcopal Communion" and you have entered the PAYOR INFORMATION. Do not send BLANK money orders. Mail to -

Continuing Evangelical Episcopal Communion
ATTN: 2021 SYNOD
124 Bedstone Drive
Saint Johns FL 32259

FOR PAYMENTS ONSITE:

Onsite payments will be accepted via credit/debit card and cash.
Checks will not accepted.

FOR PAYMENT BY CREDIT CARD

USD Total Fees Due

Credit Card Owner
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Synod 2021 Registration