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AWAKENING
Encountering God through Fresh Eyes

Registration Form

Registration is only confirmed upon receipt of this form and your registration fee(s).
You may pay with your credit card, or mail in a check. Complete the information below and click on NEXT.

2010 Leader's Retreat Registration Form
(*) Required fields.
Payment*




Name*
Home Address*
City*
State*
Zip Code*
Home Phone*
Cell Phone (optional)
Email*
Age* (check one)




Church / Organization*
Church / Organization Address
Church / Organization City
Church / Organization State
Church / Organization Zip Code
Church Phone (optional)
Ministry Title / Position
Please select the statement that best describes you: *

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