International Apostolic Prophetic Conference 2009
Please provide the following information:
(Return this form complete with workshop selections listed below and checks/money orders)
PLEASE PRINT OR TYPE: To register by phone call 1 (215) 848 - 0900
Note: You can register by phone or in person and may pay with a credit card, check, or cash along with this form
Mr.
Ms.
Mrs. _________________________________________________________
Name and Title (including Ministerial Titles)
Mailing Address_______________________________________________
City, State, Zip Code___________________________________________
Telephone____________________________________________________
Fax_________________________ E-Mail__________________________
Registration Fees: $50/per adult, $25/ 12-16 yrs old
(lunch is included with registration fee)
Payment Information (Full registration must be paid before you are officially registered)
Confirming phone registration:#_________________________________
Mail check payable to: DVPC
Check #____________________ Check Amt.____________________
Cash Payment ______________ Receipt #: _____________________
Charge to: MASTER CARD VISA CARD___ DISCOVER CARD___ DEBIT CARD
Card number ________________________ Expiration date___________
Signature_____________________________________________
Email application and credit card info to: dvpconference@yahoo.com
Fill In the name of your Workshop Selections here
WS #1 ______________________ WS #2 ______________________ WS #3 ____________________
Your Samuel Elijah Prophetic Company membership number:__ __ __ __
If you attended the 2006 and/or 2007 Conference, Who was your Presbyter?___________________________________
Send Form to: 501 West King St, Philadelphia, PA 19144
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