Jesus Seminar on the Road
Printable Registration Form |
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I would like to register for the following Jesus Seminar on the Road program(s):
Name*
Address
City
State Zip
Country
E-mail
*Please also provide the names of additional family members for name tags.
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# Events |
# Persons |
Total Price |
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$75 |
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Pre-registration (see deadline above) |
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$60 |
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Additional Family Members |
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$50 |
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$20 |
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Saturday Morning Workshop |
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$30 |
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Saturday Afternoon Workshop |
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$30 |
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Check or money order enclosed, payable to Westar Institute
(U.S. dollars drawn on a U.S. bank only)
Please bill my Visa M/C Discover AmEx
Card Number
Security Code (Visa only)________________________
(the last three digits in the signature block on the back of the card)
Exp. Date Signature
Day Phone
Print, complete, and mail or fax this form to:Westar Institute
Willamette University
900 State Street
Salem, OR 97301
tollfree (877) 523-3545, (503) 375-5323, fax (503) 375-5324
email events@westarinstitute.org
or send to the local contact address listed on the program page. |
