Which conference date(s) are you registering for?
Tamarac, FL (June 29)
Name
*
First Name
Last Name
Phone Number
*
(###)
###
####
Email
*
Are you registering for yourself only or for a spouse as well?
*
I am registering for myself.
I am registering for myself and my spouse.
Spouse's Name
Please type "NA" in each text box if not applicable.
First Name
Last Name
Will you be attending the conference with a child or children?
*
Please be advised that children ages 0-12 are free, children ages 13-17 require a cost of $125 per child.
If so, how many children are attending with you?
1
2
3
4
5+
Age(s) of child/children:
*
If not bringing a child/children, Enter N/A.
Childcare Liability Acknowledgement
*
Have you purchased/read the "Deliver Me O God" book and/or taken our Deliverance Teaching Session?
Select all that apply.
Consent and Media Acknowledgement:
*
Media Acknowledgement
*
Emergency Contact Information:
*
First Name
Last Name
Phone
*
(###)
###
####
Relationship
*
