Apostolic Intensive 2011

REGISTRATION FORM

Apostolic Intensive 2012

Please fill out the registration form then make payment through paypal.
Your registration will not be accepted if payment does not go through.

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Registration Options

Single Group Couple

Contact Details for Registration

Registration Details

Group Coordinator's Details

*First Name: - This can't be blank.
*Last Name: - This can't be blank.
*Street Address: - This can't be blank.
*Suburb: - This can't be blank.
*State:
*Post Code: - This can't be blank.
Phone:
*Mobile/Phone: - This can't be blank.
*Email: - This has to be a valid email address.
Church name:
Church suburb/town:
Senior minister's name:
*Name on Credit Card: - This can't be blank.
*Cardholder's Phone No.: - This can't be blank.
Youth Coordinator's full name:
Gender:
Age:

Participant Details

Number of participants:

Number of children:

  Firstname Lastname Gender Age
1 Adult 1 (included)
2 Adult 2 (included)
3 Child 1 (included)
4 Child 2 (included)
5 Child 3 (extra $30)
6 Child 4 (extra $30)
7 Child 5 (extra $30)
8 Child 6 (extra $30)
9 Child 7 (extra $30)
10 Child 8 (extra $30)
11 Child 9 (extra $30)
12 Child 10 (extra $30)
13 Child 11 (extra $30)
14 Child 12 (extra $30)
15 Child 13 (extra $30)
16 Child 14 (extra $30)
17 Child 15 (extra $30)
18 Child 16 (extra $30)
19 Child 17 (extra $30)
20 Child 18 (extra $30)

Cost:
Total Participation Cost($):

Clicking on "Submit" below will take you to the Paypal Checkout Page. You don't need a paypal account.
To pay using a Credit or Debit card, click "Don't have a Paypal Account" in the next page.