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The Teaching Ministry of Pastor and Educator
with John and Caroline Westerhoff
Registration Form

February 9 & 10, 2007
Hancock United Church of Christ in Lexington

Use this form if you plan to pay by credit card. Once you fill out your registration information and submit it, you will be taken to a secure server to process your credit card.

Required fields are in bold.

If you are registering more than one person from your church on your charge card, please have their names and contact information ready.

Please indicate how many people you are registering:

Individual	$110 ($100 + $10 late fee)
Clergy & Christian Educator	$160 ($150 + $10 late fee)
Team of 5 from same setting	$260 ($250 + $10 late fee )
Seminary student	$85 ($75 + $10 late fee)

Registration deadline is January 15, 2007.
A $10 late fee will be added if registering between January 15 and January 31.

Your contact information:

First Name:

Last Name:

Address:

City:

State:

Zip:

Home Phone:

Office Phone:

Email:

Church Name:

Church City/Town:

Scroll to the bottom and click "submit" if you are finished entering information, or continue:
Person 2:

First Name:

Last Name:

Address:

City:

State:

Zip:

Home Phone:

Office Phone:

Email:

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Person 3:

First Name:

Last Name:

Address:

City:

State:

Zip:

Home Phone:

Office Phone:

Email:

Scroll to the bottom and click "submit" if you are finished entering information, or continue:
Person 4:

First Name:

Last Name:

Address:

City:

State:

Zip:

Home Phone:

Office Phone:

Email:

Scroll to the bottom and click "submit" if you are finished entering information, or continue:
Person 5:

First Name:

Last Name:

Address:

City:

State:

Zip:

Home Phone:

Office Phone:

Email:

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The Teaching Ministry of Pastor and Educator with John and Caroline Westerhoff Registration Form

February 9 & 10, 2007 Hancock United Church of Christ in Lexington

The Teaching Ministry of Pastor and Educator
with John and Caroline Westerhoff
Registration Form

February 9 & 10, 2007
Hancock United Church of Christ in Lexington