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KJ 5TH ANNUAL SILVER WELLNESS WEEKEND
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15
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1
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2
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3
Address
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Street Address
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Nicaragua
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Niue
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Turkish Republic of Northern Cyprus
Northern Mariana
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Oman
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Pitcairn Islands
Poland
Portugal
Puerto Rico
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Republic of the Congo
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Saint Lucia
Saint Martin
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San Marino
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Senegal
Serbia
Seychelles
Sierra Leone
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Solomon Islands
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South Africa
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Spain
Sri Lanka
Sudan
Suriname
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eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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4
Phone Number
Text Messages may be sent to the number provided below. Do not enter phone number if you do not want to receive text messages.
Please enter a valid phone number.
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5
Date of Registration
-
Date
Year
Month
Day
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6
Bowling Tournament-Thursday: 4-5:30pm
Will you participate in the Bowling Tournament Thursday before the "Welcome Experience"?
YES
NO
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7
Do you have a product to showcase?
No table fee...minimum 10% donation to Kingdom Jewels Inc....or...$50 table fee
Name of Company
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8
Showcase Selection
Select one
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10% donation to Kingdom Jewels Inc.
$50 table fee
Please Select
Please Select
10% donation to Kingdom Jewels Inc.
$50 table fee
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9
Email for payment link
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10
Full Registration Package-$150
Thursday/Friday/Saturday Events
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NO
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11
Welcome Experience ONLY-$45.00
Thursday Event ONLY-7:30-10pm: "Its A Family Affair Game Night and Lite Bites
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12
Wellness Symposium-Free
Friday-Wellness Symposium ONLY-9am to 3pm-LUNCH on your own
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NO
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13
Motown Explosion ONLY-$65.00
Friday Evening-7pm -10:00 pm/Dinner-Dance/Live Band-"The Movement"
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NO
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14
Spiritual Wellness Brunch-$50.00-11:00am-2pm
"Bridging Generations with Love"-Guest Speakers-Elder Patricia Butler/Lady Shronda Pierson/Prophetess Mona Ricks
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NO
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15
Not able to attend? Sending a Donation
Make sure you complete the demographic info above along with the email to send a payment link
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NO
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