INFLUENCE - Registration - Mission Resourcing

REGISTRATION - INFLUENCE 2019

* Indicates required field

FULL NAME *

First

Last

DOB (dd/mm/yyyy) *

EMAIL *

YOUR CHURCH/PARISH *

SYNOD REPRESENTING *

PHONE NUMBER *

ANY HEALTH DIETARY REQUIREMENTS *

I REQUIRE ACCOMMODATION OPTION INFO (Optional) *

Yes

*IF FROM HAMILTON ONLY - I'M INTERESTED IN PROVIDING ACCOMMODATION TO ATTENDEES *

Yes

MEDIA PERMISSION - I give permission to be photographed/videoed throughout this event, for use in future promotional material *

Yes No Unsure

Submit

1 Corinthians 11.1