REGISTRATION for Emotional Pain Event
Tuesday, August 12th at Shelton Bible Baptist Church - 421 West E St., Shelton (across from cemetary) - BBQ Dinner 6pm / Event at 7pm
Name
*
First Name
Last Name
Will you be attending the BBQ at 6pm before the event?
*
Yes
No
Will anyone be attending with you?
Yes
No
If yes, how many attending with you?
E-mail
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Phone Number
Address (optional)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Comments
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