2023 Leadership Seminar Registration
April 21 - 7:30pm | Please fill out this form and click submit.
The cost is $35.00 per person.
The cost includes all sessions and meals. Free childcare is provided for registered children.
Location:
Apostolic Pentecostal Church
2810 Tractor Lane
Bloomington, IL 61704
Speaker: Dr. Eugene Wilson
Schedule:
Friday - 7:30pm
Fellowship Meal to follow for all attendees in the Lower Level Dining Room
Saturday
Breakfast - 8am
Session 1 - 9am (Department Committees meet separately at this time.)
Session 2 - 10am
Session 3 - 11am
Name
*
Email
*
This address will receive a confirmation email
Childcare
I need child care (ages up to 3)
Please select one option.
1
2
3
4
4
Select Option
1
2
3
4
4
I need child care (ages 4 to 11)
Please select one option.
1
2
3
4
5
Select Option
1
2
3
4
5
Please list names and ages of children
Children's Allergies
Registration Payment
Payment
Single Reg ($35.00)
2 Reg ($70)
3 Reg ($105)
4 Reg ($140)
5 Reg ($175)
Ladies Sectional Director Registration (0)
NAM Sectional Director Registration (0)
Sunday school Sectional Director Registration (0)
IYM Sectional Director Registration (0)
District Board Registration (0)
Camp Promotional Committee Registration (0)
Staff (0)
Cash or check ($0)
NAM Missionary ($0)
Men's Sectional Director (0)
Sectional Prayer Coordinator (0)
Sectional Secretary (0)
Single Reg ($35.00)
2 Reg ($70)
3 Reg ($105)
4 Reg ($140)
5 Reg ($175)
Ladies Sectional Director Registration (0)
NAM Sectional Director Registration (0)
Sunday school Sectional Director Registration (0)
IYM Sectional Director Registration (0)
District Board Registration (0)
Camp Promotional Committee Registration (0)
Staff (0)
Cash or check ($0)
NAM Missionary ($0)
Men's Sectional Director (0)
Sectional Prayer Coordinator (0)
Sectional Secretary (0)
Amount
If paying Cash/Check, please list the ministry couples that will be attending.
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
April 21 - 7:30pm
Please fill out this form and click submit.
The cost is $35.00 per person.
The cost includes all sessions and meals. Free childcare is provided for registered children.
Location:
Apostolic Pentecostal Church
2810 Tractor Lane
Bloomington, IL 61704
Speaker: Dr. Eugene Wilson
Schedule:
Friday - 7:30pm
Fellowship Meal to follow for all attendees in the Lower Level Dining Room
Saturday
Breakfast - 8am
Session 1 - 9am (Department Committees meet separately at this time.)
Session 2 - 10am
Session 3 - 11am
×
Please Fix the Following