REQUEST BROCHURE OR REGISTER
Dayspring Registration Form
April 24-27, 2003
Register now for just $25.00 and we will begin invoicing you.
Take advantage of this payment plan and be paid in full when the conference arrives!
Name
Address
City
State
Zip Code
Email
Telephone Home
Telephone Work
Marital Status:
Single
Married
I only want the brochure
Registration for the conference is $115
Preregister for only $25!
Payment method
Payment Method
VISA
MasterCard
America Express
Discover
Check
Money Order
Check or Money Order in the amount of
Credit Card Number
Expiration Date
Amount
Recurring payments
You may bill my credit card on the 15th each month for
Amount
$25
$30
$35
$40
$45
$50
$55
$60
I will make my own hotel reservation.
If not paid in full, a $5.00 administrative fee is applied.
Money is transferable but is non-refundable.
