Declaring Our Faith: Confessions in the Modern Age (PCRT26)

How many people are you registering? *

(including yourself)

First Participant

Email Address *

Prefix *

First Name *

Last Name *

Street Address *

City *

State *

Postal Code *

Country *

Event Fee(s)

Pre-Conference Standard Rate

Rate after March 31st.

Standard - $ 35.00

Alliance Friends - $ 25.00

- none -

Conference Standard Rate

Rate after March 31st.

Standard - $ 85.00

Alliance Friends - $ 75.00

- none -

Total for this participant

Authorize.net (Credit Card)

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Name Badge

First Name *

Last Name *

City *

State *

Church