|
Organization—if applicable ___________________________________________________________
Street Address/Apt _________________________________________________________________
City& State ________________________________________________________________________
Zip/Postal
Code & Country ____________________________________________________________
Church/Denomination
________________________________________________________________
Email __________________________________ Daytime Telephone
_______-___________________
Registration
|
|
|
Total
|
|
Extra
Early Registration
through
February 1, 2009
|
__
Individual $159.00
|
__
Student $99.00
please show ID at registration
|
$
_________
|
|
Early
Registration
through
May 15, 2009
|
__
Individual $199.00
|
__
Student $139.00
please show ID at registration
|
$
_________
|
Regular
Registration
after
May 15, 2009 |
__
Individual $219.00
i
|
__
Student $159.00
please show ID at registration
|
$
_________
|
Group
Rate per Person
when
3 or more register together |
__
$139.00 per person
through
February 1, 2009
|
__
$179.00 per person
after February 1, 2009
|
$
_________
|
| Partner
Church or Sponsor Organization Registration |
__
$129.00 per person
through
February 1, 2009
|
__
$169.00 per person
after February 1, 2009
|
$
_________
|
One
Day Registration
Sunday/Wednesday or Monday or Tuesday |
__
$75.00 per person
per day
|
x
# days _______ =
|
$
_________
|
|
Please list day(s) of attendance _______________________________________________________________________ |
| Additional/Optional
Costs |
Workshop
Track Participation
includes
Sunday, June 21 supper & Wednesday, June 24
lunch; cost in addition to conference registration
|
__
$99.00 per person
through February 1, 2009
__ $109.00 per person
through
May 15, 2009
|
__
$119.00 per person
after May 15, 2009
|
$
_________
|
Please
Circle Workshop Track Choice:
Young
People — Church Leadership — The Arts
— Business — Apprentice — Post-Secular
— Spiritual Direction |
| Contribution
to The With-God Life Conference Scholarship Fund |
$
_________
|
|
Total
=
|
$
_________
|
Please indicate if you have a disability and
need assistance. Please list needs, including
type of hearing assistance/sign language interpretation
required:
__________________________________________________________________________________________
|
Method
of Payment
Payment
of the full fee is necessary to register. Register online
at www.renovare.org
or mail complete registration form and check, money
order, or credit card information to:
RENOVARÉ
8 Inverness DR E - Ste 102
Englewood, CO, 80112-5609
Attn: 2009 IC Registration
or fax form with credit card information to 303-792-0146.
Please
check one:
____
Check or Money Order enclosed. (Payable to “RENOVARÉ”
in U.S. Funds.)
____
Charge my (circle one): AMEX - Discovercard - Mastercard
- Visa
Amount $ ____________ Card # ____________________________________
Exp. Date __________
Name on Card _____________________________ Signature
_________________________________
|
