Registration Form
(Print and send form to: P.O. Box 187 State Park,SC 29147 or Fax:(803) 252-1150)
Name: __________________________________
Full Address: _______________________________________________
Home Phone: _____________________ Other Phone: ______________
Name of Event: _____________________________________________
Date(s) You're Attending the Event: ____________________________
___________________________________________________________
Church Affiliation(and location): ___________________________________________________________
___________________________________________________________
Senior Pastor: ______________________________________________
Method of Payment (CIRCLE ONE): CASH CHECK
MONEY ORDER
(If form is faxed, payment must be recieved before being registered)
