| Names of additional family members (living in my same household) who will be going with me: |
1. Note: this is for support staff
2. only, all speakers need to
3. register individually
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Zip: |
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Telephone: |
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| Birthdate: |
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| Home church & conference: |
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| I'm signing up as/for (check all that apply): |
Speaker (check applicable lines below) |
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I need a translator |
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I speak Spanish (I don't need a translator) |
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I will preach a full series |
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I will preach a student series |
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Support staff for (list speaker below)
I speak Spanish and am willing to translate for another speaker
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Building Project (must be able to raise an additional $500 for this project)
Medical Clinic
I am a doctor
I am a nurse
I have no training but would like to assist
Check the appropriate box below. I am a...
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Pastor or retired Pastor |
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Lay Member |
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College or University Student |
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Academy Student |
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| Lodging Arrangements: |
I understand that each person is responsible for their own room charges. With that in mind, I prefer the following lodging arrangements (select option below) |
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Room with other roommate(s)
(If you have a roommate(s) already selected, indicate name(s) below)
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Room with spouse/family (list room occupants below)
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Room alone (additional cost) |
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Message:
(Please let us know
of any further comments or
questions you
may have.)
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As soon as your ticket is purchased please e-mail the following information to npucmissions@nw.npuc.org.
- Arrival date & time at final destination
- Airline & flight number
- Departure date & time
We do NOT need your entire itinerary--only the above items. The local church leaders need this information to know which flights to meet and when to begin hotel reservations.
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| Enter code: |
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Enter the code in the graphic below to help eliminate spam entries.
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THANK YOU for being willing to partner with God in the Great Gospel Commission! |
