Reverend Patricia Saunders, CEO/President - Domestic Violence   HIV/AIDS   Homicide   Pastoral Care
REGISTRATION FORM 2017
First Attendee
Yes
No
REGISTRATION FORM - Pastoral Care Chaplaincy Program Workshop
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
NO FEE EVENT Walk & Pray for Peace
Registration Fee
At the Door CASH ONLY
Donation any Amount $_________
No Refunds after February 17, 2017
CIT/Chaplains $10.00
Other Attendees $15.00
At the Door $20.00
Check or Money Order was Mailed:
Option #1
DCAEHS, Inc. P.O. Box 92246, Washington, DC 20090