Reverend Patricia Saunders, CEO/President - Domestic Violence   HIV/AIDS   Homicide   Pastoral Care
REGISTRATION FORM 2017
First Attendee
Yes
No
REGISTRATION FORM - National Pastoral Care Domestic Violence Conference
Clergy or Leadership Titles Select One
Name - (Last, First, M.I.)
Name of your Church
Address 1 - (Street, Suite/Apt.#)
Address 2 - (City, State, Zip)
Cell Phone Number
E-mail Address
Executive Assistant Name
Telephone Number
Payment Option
PayPal - ALL REGISTRATIONS ON-LINE
Cash/Check or Money Order - MAILED OR ON-SITE ONLY
Registration Fee
Register On-line you MUST Pay on-line or by Mail
Registration Fee $45.00 In advance
At the Door CASH ONLY $50.00
Vendors MUST Register + $10.00 Per Table
CIT/Chaplains $40.00
No Refunds after October 18, 2017
Donation any Amount $_________
Check or Money Order was Mailed:
P.O. Box 8753 Hyattsville, MD 20787