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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:

Denomination:

Church Postal Add.: Church Tel. Nr.:

Church Fax Nr.:

REGISTRANT (DELEGATE) INFORMATION Title:

Mr

Mrs

Miss/Ms.

Rev.

Pastor

Dr.

Surname: Surname: Postal Address:

Name:

Cellular Nr:

Telephone: Nr:

Email Address:

Prof.

(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!!

Urban Leaders

$10.00

Rural Leaders

$5.00

Faculty Staff/Student

$5.00

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

Payable To:

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: mupresby@zol.co.zw info@livingwaterschurch.co.za

Registration Form - Global Leadership Summit Zimbabwe  

Registration Form

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