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Conference Registration Form

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Please print this page and place it in an envelope and mail it with your contribution to:                                                                  Million Member Assembly                                                                                                                                                                                   Conference Registration                                                                                                                                                                                       P. O. Box 1052 New York, NY 10150-1052                                                                                                                                                    Make your check payable to: Million Member Assembly

 

Please identify and describe yourself:

Name
Sex Male Female

Please provide the following contact information:

Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
Web site (optional)

Please Select one of the following information:

Category

Please provide the following registration information:

DATE

CONFERENCE  DESCRIPTION  &  LOCATION

Choose one of the following options:

Select any of the following conference options that apply to your interest:

The Issues: New York City, Monday, July 7, 2008.
The Issues: Philadelphia, PA, Friday, July 11, 2008.
The Issues: Atlanta, GA, Monday, July 14, 2008.
The Issues: Orlando, FL, Friday, July 18, 2008.
The Issues: Los Angeles, CA, Monday, July 21, 2008.
The Issues: Chicago, IL, Friday, July 25, 2008.
The Issues: Pittsburgh, PA, Monday, July 28, 2008.
The Issues: Las Vegas, NE, Friday, Aug 1, 2008.

Select any of the following conference options that apply to your interest:

Understanding America Today: Boston, MA, Monday, Aug 18, 2008.
Understanding America Today: Washington, DC, Friday, Aug 22, 2008.
Understanding America Today: Brooklyn, NY, Monday, Aug 25, 2008.
Understanding America Today: New Orleans, LA, Friday, Aug 29, 2008.
Understanding America Today: Denver, CO, Monday, Sept 8, 2008.
Understanding America Today: Miami, FL, Friday,  Sept 12, 2008.
Understanding America Today: Detroit, MI, Monday, Sep15, 2008.
Understanding America Today: San Francisco, CA, Friday, Sept 19, 2008.
 

Select any of the following conference options that apply to your interest:

Your Community & Their Urgent Needs: Louisville, KY, Monday, Sept 29, 2008
Your Community & Their Urgent Needs: Seattle, WA, Friday, Oct 3, 2008
Your Community & Their Urgent Needs: Des Moines, IA, Monday, Oct 6, 2008
Your Community & Their Urgent Needs: Houston, TX, Friday, Oct 10, 2008
Community & Their Urgent Needs: Charleston, SC, Monday, Oct 13, 2008
Your Community & Their Urgent Needs: St. Louis, MO, Friday, Oct 17, 2008
Your Community & Their Urgent Needs: Los Angeles, CA, Monday, Oct 20, 2008
Your Community & Their Urgent Needs: New York City, Friday, Oct 24, 2008
 

I want to support Pastor for Pastor with a donation of $:


Registration Date


My comments are:


Please print this page and place it in an envelope and mail it with your contribution to:                                                                  Million Member Assembly                                                                                                                                                                                   Conference Registration                                                                                                                                                                                       P. O. Box 1052 New York, NY 10150-1052                                                                                                                                                    Make your check payable to: Million Member Assembly

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