PC Registration Form

Your Name*

First Name

*

Last Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Phone Number*

Format: (000) 000-0000.

Church

YesNo

Will book hotel on my ownRequesting on-campus housing - available on a first-come, first-serve basis for singles only. ($25 for 1-4 nights and $10 for each additional night)I'm requesting off-campus housing with a church member (limited availability on a first-come, first-serve basis)Other

Will be driving.Will be flying. While transportation to and from the airport is not automatically provided, arrangements may be made for the cost of pickup or drop off.Other

Arrival Day and Time

Departure Day and Time

Names of additional adults attending

Names of teens attending

Number of children ages 6-12 that will be attending with me.

Names of children ages 6-12

Number of children ages 3-5 that will be attending with me.

Names of children ages 3-5

Number of children ages 0-2 that will be attending with me.

Names of children ages 0-2

Total Number of Adults Attending

Total Number of Teens Attending

Total Number of Children Attending

Total Number Registered

Calculation Field

PLEASE PAY REGISTRATION FEES USING THE FORM BELOW.

$50 per adult and teens
$25 per child for 4-10 years old
No cost for 0-3 years old
Registration is provided to senior pastors & missionaries (and their wives) by our Sunday school offerings.

Registration

Registration Fee

$50.00

	Quantity	Price
Adult		$50.00
Senior Pastor/Missionary (including spouse)		$0.00
Teens		$50.00
Children 4-10		$25.00

Item subtotal:$0.00

On Campus Lodging Fee

$25 for 1-4 nights per person ($10 for each additional night per person)

$25.00 PeopleNights
Item subtotal:$0.00

Total

$0.00

Credit Card Info

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Comments

2026 Preaching Conference Registration