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Registration Form Please complete one registration form per person. (NB: Mark relevant “boxes” with an ‘X’)
MUTARE, ZIMBABWE – 25-26 NOVEMBER 2010
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*Registration Closing Date : Monday before event!!
CHURCH/ MINISTRY/ ORGANISATION INFORMATION Are you a WCA (Willow Creek) Member?
If NOT, would you like to join?
WCASA Member: Nr: SA Church/Org.Name:
Church Postal Add.: Church Tel. Nr.:
Church Fax Nr.:
REGISTRANT (DELEGATE) INFORMATION Title:
Surname: Surname: Postal Address:
(NB!) Please take note that Confirmation will be sent to your email address!
CONFERENCE FEES (Per Person) (Fees Include Conference Note-Book, Light Lunch & Refreshments) Regular Rate/s
Valid Until Conf Reg. Closing Date!!
PLEASE TAKE NOTE: PROOF/CONFIRMATION OF PAYMENT MUST BE ATTACHED to your Registration Form when registering!
(If Faculty/Student, State College/Institution/Student Nr.):
No Refunds of Conference Fees will be paid out as a result of cancellations or non-attendance.
*Please Give 2 Weeks Allowance for Registration To Be Processed… Confirmation will be sent thereafter!
PAYMENT OPTIONS Cheque Deposit / Internet Transfer / Bank Deposit
Cash AMOUNT ATTACHED:
Not Available in Africa
REGISTRATION POINTS MUTARE: St Columba’s Presbyterian, Lighthouse Christian Church HARARE: River of Life Church, Westgate & Eastlea BULAWAYO: Word Of Life Ministries
Tel: +263.772.776.655 or +27.31.563.5227 E-mail: firstname.lastname@example.org email@example.com