Full Name
*
First Name
Last Name
Suffix
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Group Conference Information
Enter the First and Last names of the men attending the conference below. Separate each person's name with a comma. (i.e. John Doe, Bill Bob, Ed Jones)
Age Ranges of Men Attending Conference
*
12-14
15-18
19-25
26-35
36-45
46-55
56+
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Name of Church (Put NONE if not a member of a Church)
*
Name of Senior Pastor
First Name
Last Name
Address of Church
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Payment (If not paid already)
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Kings & Priests Registration
$
30.00
Quantity
Kings & Priests T-Shirt (Optional)
$
15.00
Quantity
Submit
Should be Empty: