Clone of Region IX COOLJC Registration

REGION IX CONFERENCE REGISTRATION

June 12-13, 2026, | True Way Church | Nashville, TN
I AM READY TO ALIGN!!!
Title
Name

First NameLast Name
WOULD YOU LIKE TO SERVE?
Home Church
Diocese
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile Phone
E-mail
Additional Registrants
Name

PrefixFirst NameLast Name
Age
Name

First NameLast Name
Age
Name

First NameLast Name
Age
Name

First NameLast Name
Age
Name

First NameLast Name
Age
Dietary Restrictions (Meals are included)
Email
example@example.com

Registration
Registration Product Image

Registration$20.00

Quantity
Item subtotal:

T-Shirt(s)
Region IX T-Shirt Product Image

Region IX T-Shirt$20.00

Item subtotal:

Total $0.00

Payment Methods

Choose from one of the PayPal options to make your payment.
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REGION IX CONFERENCE REGISTRATION