Beth Moore - Living Proof Live Simulcast

Beth Moore - Living Proof Live Simulcast Registration
Required Required Question(s)
Required 1.

Please enter the information indicated below.
First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
City:
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2.

Are you registering others?  If so, please list their names below.
The cost is $25 per person.
 

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3.

Will you or any others need child care?  If so, please list the names and ages of the children below.  The cost for child care is $5 per child for the day. 
This includes lunch (Children will eat lunch with their parents).
Yes
No
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4.

Are you registered for Women Who Move discipleship  2010-11?  If so, you receive a $5 discount for this Beth Moore Living Proof Live Simulcast.  For more information about Women Who Move, go to: http://www.cohlc.org/connect_adult_women.htm

Yes - I am registered for Women Who Move 2010-11 at CoH
No - I am not registered for Women Who Move 2010-11 at CoH
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Required 5.


Please check one box below and then click finish to go to the secure payment page.
$25 - Single registration fee
$30 - Single registration fee + 1 child
$35 - Single registration fee + 2 children
$40 - Single registration fee + 3 children
$20 - I am registered for Women Who Move 2010-11 at CoH
$25 - I am registered for Women Who Move 2010-11 at CoH + 1 child
$30 - I am registered for Women Who Move 2010-11 at CoH + 2 children
$35 - I am registered for Women Who Move 2010-11 at CoH + 3 children
Other  
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