Charity Virkler Kayembe
Event Registration
Saturday, November 13
9am - 5pm
Sunday November 14
10am - 12pm
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
How many people from your family will be coming total? (including you)
Would you like to receive emails concerning any future events?
Yes
No
What services will you be attending?
Both Saturday and Sunday
Just Saturday
Just Sunday
Not sure yet
Please list their names here:
Submit
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