Praise Christian Center World Outreach

Conference Sign Up Form

Registration deadline is May 19, 2005. Late registrations will incur a $10 late charge.

Number of Adults Attending?: Per Adult - $60
I am a J.R. S.T.A.R. (Ages 13-19) Registration - $30
I am a Mini-S.T.A.R. (Ages 6-12) Registration - $15

PRODUCT INFORMATION
In addition to registration, General sessions conference CD's and tapes may be pre-ordered. Ordered with registration:
(7-sessions) Set(s): CD's - $55 (7-sessions) Set(s): Tapes - $32
Purchased after registration deadline: CD's - $80 and Tapes - $40

MORNING SESSIONS	EVENING SERVICES
June 2-4 * 8:30 a.m.	June 2 & 3 * 7:30 p.m.

* = Required Fields

First Name:

Title (If applicable):

Last Name:

Are you a DPU alumna? Yes or No

If Yes Enter Alumna Discount Code:

Address:

City:

State:

ZipCode:

Church Affiliation:

Home Phone:

() -

Work Phone:

() - *

Email:

Registration Hostess:

If Method of Payment is a Check make check Payable To: P.C.C.W.O.

Check #:

Drivers License No.:

State:

Total Monies: $

If Method of Payment is a Credit Card Just click on Send Request button

For more information call 281-457-5683
All Registration Funds are Non-Refundable and Non-Transferable.