I would like to register for the following Jesus Seminar on the Road program(s):
Name*
Address
City
State
Zip
Country
E-mail
*Please also provide the names of additional family members for name tags.
|
|
|
# Events |
# Persons |
Total Price |
|
|
$75 |
|
|
|
Pre-registration (see deadline above) |
|
$60 |
|
|
|
Additional Family Members |
|
$50 |
|
|
|
|
|
|
|
|
|
|
|
$20 |
|
|
|
Saturday Morning Workshop |
|
$30 |
|
|
|
Saturday Afternoon Workshop |
|
$30 |
|
|
|
|
|
|
|
|
|
Check or money order enclosed, payable to Westar Institute
(U.S. dollars drawn on a U.S. bank only)
Please bill my
Visa
M/C
Discover
AmEx
Card Number
Security Code (Visa only)________________________
(the last three digits in the signature block on the back of the card)
Exp. Date Signature
Day Phone
Print, complete, and mail or fax this form to:Westar Institute
P.O. Box 7268
Santa Rosa, CA 95407
tollfree (877) 523-3545, (707) 523-1323, fax (707) 523-1350
email events@westarinstitute.org
or send to the local contact address listed on the program page.