Wufoo

Learning Community Registration

November 9-10, 2009
Pacific Palms Resort, City of Industry
(Registration is required for all Full-Time Pastors)

Complete and "Submit" below.
Red asterisk (*) denotes required fields, in order for "Submit" button to work.

PLEASE COMPLETE FORM NO LATER THAN OCTOBER 12, 2009

Name * First Last
Email *
Position *
Church *
Phone Number * ### - ### - ####
Preferences & Registration info for Full-Time Pastors (and Part-Time Pastors intending to attend the full LC event)

Complete all fields that apply.
Select which applies
I will be staying at the Pacific Palms Resort as a single (Rooms based on double-occupancy). I am bringing a guest and will pay for their registration costs ($165). I am bringing my spouse and will pay for their registration costs ($165).

$165 for spouse or extra guest; includes all meals.
Name of spouse (if coming): First Last
$165 for spouse or extra guest; includes all meals.
Name of guest (if coming): First Last
$165 for spouse or extra guest; includes all meals.
Name of roommate preference: First Last
Vegetarian meals requested
For myself For my spouse For my guest
Additional Notes:
Options for Part-Time and Bi-Vocational Pastors

If you are a part-time or bi-vocational pastor and can come to the ENTIRE EVENT, then please select from the registration information offered in the "full-time" section above.

If you CANNOT attend or can only PARTIALLY attend, then please complete all fields that apply below.
Attendance:
I cannot attend at this time. I can only attend part-time. Please reserve a plate for me at the following meals (shown below).
In coming part-time, I can attend these meals/have these preferences:
Lunch - 11/9 Dinner - 11/9 Breakfast - 11/10 Lunch - 11/10 I request vegetarian meals*
* In selecting this option, please don't forget to also check WHICH days/meals you intend to come.
Do Not Fill This Out

Wufoo

Learning Community Registration

Preferences & Registration info for Full-Time Pastors (and Part-Time Pastors intending to attend the full LC event)

Options for Part-Time and Bi-Vocational Pastors