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Midwest Regional Conference-- Chicago
September 26-28, 2017
Registration must be received by September 7, 2016
*
Indicates required field
Name
*
First
Last
Phone Number
*
Email
*
Church/Institution
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Room Type (All rooms non-smoking)
*
Single Room
Shared Room
Room with Spouse
None (Commuting or Hotel)
Roommate Preference
*
Registration Fee (Program Cost):
Active Pastors
*
1
2
3
4
5
0
$125 per active pastor (even if he should excuse himself from this mandatory conference)
Church Workers/ED Staff
*
0
1
2
3
4
5
$75 per Professional Church Worker or English District Staff
Vicar/Retired
*
0
1
2
3
4
5
$50 per Vicar, Emeritus Pastor, Retired Church Worker
Food/Lodging
*
0
1
2
3
4
5
$170 per person
Single Room
*
0
1
2
3
4
5
Add $40 for a single room
Commuter
*
0
1
2
3
4
5
$90 if not staying at The Cenacle
Spouse Food/Lodging
*
0
1
2
3
4
5
$170 per Spouse (food and lodging)
Total Amount Due
*
This is the dollar amount due
Please add up all Registration Fees+Food/Lodging and enter amount in the box.
Travel
*
Driving Own Car
Bus or Rail
Flying
Riding in Car with others
Travel Info
*
If driving please list other passengers.
If traveling by bus, rail, or airline, please list:
Carrier
Flight or Route Number
Arrival Time
Submit