Servants' Summit Registration Form
First Name
*
Last Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Date
-
Month
-
Day
Year
Date
Registration Option:
*
Conference Only (No Lodging)
Conference with on campus lodging (limited availability)
Do you need first-floor housing due to mobility limitations? (Our Lodge does not have an elevator)
Yes
No
Preferred, but not required
Are you planning to attend the complimentary lunch on Saturday?
Yes
No
Attendees:
*
Single
Couple
Spouse Name:
First Name
Last Name
Are you or your attending spouse ABC alumni or current staff?
*
Yes
No
List any dietary restrictions you and/or your attending spouse have:
ex. John: gluten-free, Jane: nut allergy
Select an optional activity for Friday afternoon: Other area activities are available to visit on your own
*
Trout Fishing at ABC's stocked pond - $15.00
Hawks Nest and Contentment Historical House Tour - $10.00
New River Gorge Scenic Overlook and Visitor Center Tour (non-strenuous) - $10.00
None of the Above
Select an optional activity for Friday afternoon for your spouse:
Trout Fishing at ABC's stocked pond - $15.00
Hawks Nest and Contentment Historical House Tour - $10.00
New River Gorge Scenic Overlook and Visitor Center Tour (non-strenuous) - $10.00
None of the Above
activity_fees
Registration Total
payment_amount
payment_description
payment_first_name
payment_last_name
payment_address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
payment_phone
payment_email
payment_comment
payment_fund_number
payment_instructions
payment_order_id
Submit
Should be Empty: