Women's Conference Registration

register here!

Name

First Name

Last Name

Email

Please provide an email you check regularly.

Phone

Please provide a cell phone number.

(###)

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T-Shirt Size

Is there someone you'd like to be seated with at a table (meals and discussions)?

For example, someone you're bringing to the conference.

Do you have any dietary restrictions?

What are you most looking forward to for this conference?

Would you like to donate a partial or full scholarship so that everyone can attend the conference?

If so, please list the amount below. We ask that you submit a separate check or payment with a note in the memo line "Scholarship Donation."

Payment

Please have your $80 payment turned into the main office no later than April 25th.

If you are in need of a scholarship, please fill out the form below.

Name

First Name

Last Name

Email

Phone

(###)

###

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How of a scholarship are you requesting?

For example, 25%, 50%, 75%, 100% or if other amount, please list that amount here.

Why do you desire to attend this conference?