Please be sure to fill out all required fields marked with an * 
When finished, please hit "Submit" button at bottom.

Pastor or Director of Parachurch Ministry's Name:*
Church or Parachurch Ministry Name:*
Church/Parachurch Ministry Mailing Address:*
Church or Parachurch Ministry Phone Number:*
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Alternate Phone Number:
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E-mail Address:
Total Number Attending Choose one of the following answers:*
How did you hear about this seminar? Choose one of the following answers*
If you were referred to this seminar by phone, and you know who called, please indicate their name. Please also indicate the number you were reached at.
If you were referred to this seminar by e-mail, what is the e-mail address you were reached at?
If you were referred to this seminar by a pastor friend, please indicate their name
If you were referred to this seminar by the director of an association, please list the association's name and the director's name.