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Registration Form ~ Wednesday, October 05, 2011 - Friday, October 07, 2011
Western National Leadership Training Event
  • Those attending workshops - complete their own individual registration form.
  • Those not attending workshops - complete the non-participant portion of their spouse or friends's registration form
 
Title:
First Name:  
Last Name:  
 
 
   
 Mailing Address:  
City:  
State:  
Zip:  
   
Daytime phone:  
Cell phone:  
Email address:  
   
Mark you workshop choices in each series.  If your workshop choice is filled, you will be assigned to the other one in that time slot.

Thursday Workshops
Series 1 2:00 - 3:30 p.m.
 
Series 2 4:00 - 5:30 p.m.
 
Friday Workshops
Series 3 1:00 - 2:30 p.m.
 
Series 4 3:00 - 4:30 p.m.
 
NON-PARTICIPATING SPOUSE OR FRIEND
Non-participating spouse/friends are welcome to attend the WNLT worship services and plenary presentations at no extra charge.

There is a charge for non-participants to participate in the field tour.
First Name:
Last Name:
   
 
   
Mailing Address:
City:
State:
Zip:
   
Daytime phone:
Cell phone:
Email address:
 
 
TRAVEL ARRANGEMENTS (Registrant and Non-participant)
      Carrier:
      Arriving Flight Number:
      Arrival Date & Time:
      Departure Date & Time:
 
All registrations must be in the Synod of the Rocky Mountains office no later than Saturday, September 10, 2011 .
There will be no refunds after Saturday, September 10, 2011
   
Early Paid-in-Full Registration
( postmarked or paid via PayPal by Monday, August 15, 2011 )
OR  
Full Registration
( postmarked after Monday, August 15, 2011 )
   
   
$80.00
Total Payment Due
PLEASE READ THE STATEMENT BELOW and then check the box to the left to acknowledge that you have read the statement. You will not be able to continue until you complete this step.

** NOTICE if paying with PayPal **
Make sure you click the "Return to Synod of the Rocky Mountains" button once you have completed your payment with PayPal. THIS IS REQUIRED to apply the payment you made to our system, which includes your online account.