Reverend Patricia Saunders, CEO/President - Domestic Violence   HIV/AIDS   Homicide   Pastoral Care
REGISTRATION FORM 2015 - (ON-LINE - PAYMENT IS REQUIRED BY PAYPAL)
First Attendee
Yes
No
REGISTRATION FORM - 6th National Pastoral Care Domestic Violence Leadership Conference Saturday, October 3, 2015- 8am - 1pm
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
$45.00 Early Bird Registration - August 1, 2015
$55.00 Registration Fee
$65.00 At the Door CASH ONLY
Donation any Amount $_________
No Refunds after September 1, 2015
Check or Money Order was Mailed:
Option #1
DCAEHS, Inc. P.O. Box 92246, Washington, DC 20090