Course Registration Form

Registration Form

Fill out the form carefully for registration
Business Name
Contact Name

First NameLast Name
Contact E-mail
example@example.com
Mobile Number
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Will you be giving treats?

YesNo
Will you be hosting a game?

YesNo
If you can not host a space but would like to contribute to the event through sponsorship you can contact James or Michael about how to give towards the event.

Contact Info:

James Wilson, Next Gen Pastor, The Assembly - 601-748-5931

Michael Jenkins, Consistency Beyond Limitations - 601-748-3392
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