Kidfest 2011 Registration Form

I plan to attend the Kidfest location marked below. I understand that a $25.00 per person deposit submitted with this form will be deducted from my total Kidfest costs.

Kidfest Locations

Number of Attendees

For Frontier, Carolina, and Midwest:

Please enter the number of rooms you will need for your group. Understand by doing so that you will be financially responsible for rooms not dropped by the final rooming list date.

Number of Rooms

Church Name

State Office your church reports to

Group Leader(s)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home Phone

Area CodePhone Number

Work Phone

Area CodePhone Number

Fax

Area CodePhone Number

E-mail

A deposit of $25.00 per attendee is due upon registration. You can pay by check by sending payment to the following address:

Church of God Youth & Discipleship
ATTN: Tony Lane
PO Box 2430
Cleveland TN 37320

You may also submit your credit card on this secure form and we will charge it and send you a receipt. Please be aware that there is a 5% charge for all credit card transactions.

Would you like to pay via credit card? (5% fee applies)

Credit Card Type

Name on Card

First NameLast Name

Credit Card Number

Expiration Month

Expiration Year

Billing Zip Code

Amount to Charge

Please enter the amount you will be paying. For example, if you are bringing 16 kids and adults, the deposit amount will be $400.00. If you would like to pay the full fee, multiply that fee times the number of attendees.

If you have any questions, feel free to call our office at 423-478-7229.

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