2015 Start to Finish Registration Form

Registration Information:
Registration Type*

Seminar & Parent Qualifying Course: $95Seminar Only: $45Walk-In: $100
Seminar Location*
Check this box if your spouse is also attending (spouses attend free of charge).

Yes, my spouse is attending.
Attendee Names:
Attendee #1*

First NameLast Name
Attendee #2*

First NameLast Name
Discount Code
OVERALL TOTAL:
Check this box to confirm that you have read and agree to our cancellation policy. *

Yes, I Agree

Contact Information:
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
How Did You Hear About This Event?*

CH e-NewsletterCH BrochureFriendChurchSupport Group/Co-opFacebookOther
Comments
For office use only.

Payment Information:

Billing Details*

USDTotal Charge to Your Card

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Confirmation Sent From:
Invoice #:
Should be Empty: