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Genesis Registration
Genesis Registration
Nick Savaya
2019-08-23T19:48:04-04:00
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Please fill out the information below to register
Name
*
First
Last
Phone
*
Email
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Parish
*
Mother of God
St. Thomas
Holy Cross
Mar Addai
Sacred Heart
St. Joseph
St. George
Holy Martyrs
Our Lady of Perpetual Help
St. Paul
Mart Mariam
Other
None
Age
*
How did you hear about the conference?
*
Genesis 4:9 Mens Group
Church Announcement
Family/Friend
Social Media
Other
Today's Date
MM slash DD slash YYYY
Do you have or are you a high school student who will be joining the conference
Yes
No
Cost Per Person (If Not A High Schooler)
Quantity
Payment includes breakfast and lunch...
Price:
$40.00
Quantity
Cost Per High Schooler
Quantity
NOTE: Please bring the high school ID of the person registered so that we are able to verify them being in high school
Price:
$10.00
Quantity
Names of Attendees
Please add names of attendees including yourself if you buy 2 or more tickets.
Subtotal
$0.00
Please check below if you would like to help ECRC in covering the 3.5% credit card fees
YES
CC Processing Fees
Price:
$0.00
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Credit Card
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Supported Credit Cards: American Express, Discover, MasterCard, Visa
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Month
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Year
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