ADDRESS: ______________________________ CITY __________________ ST__ Zip ________
PHONE: (H) __________ (W) __________ Emergency phone# ___________
Church Name: ______________________________ Church Address: _________________________
Pastor's Name: _____________________ Phone: __________
CHECK ALL THAT APPLY:
FEE: $35 per person (Incl. movie and a gift certificate)
I would like to register as a:
__ Pastor __ Lay Minister __ Youth Pastor __ Christian/Inspirational Author __ Christian/ Inspirational Poet
__ Other (_____________________________________)
Name of your book(s): _________________________________________________________________________
__________________________________________________
Time:- 8:30 am - 10:00 am
Special Guest Speaker: (TBA)
*Special Musical Guests:
TBA
*Meet & greet other special guest(s):
(TBA)
*(NOTE: Each guest should fill out separate form unless attending as a couple).
*Deadline to register: April 1, 2011 (To Extend, please call to RSVP!
Call Stacey @ 901-680-2018;
MAKE MONEY ORDER or CASHIER'S CHECKS PAYABLE TO:
MEMPHIS BWC
(We no longer accept personal or business checks)
Mailing Address:
Attn: Lawrence Wayne, MBWC
C/o: Ashaun, LLC/
5100 Poplar Ave, Ste. 726 -Plaza Level* Memphis, TN 38137
901-680-2018 off
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PAY ON-LINE:
