Here We Stand: Philadelphia (PCRT23)

How many people are you registering? *

First Participant

Email Address *

Prefix *

First Name *

Last Name *

Street Address *

City *

State *

Postal Code *

Country *

Event Fee(s)

Pre-Conference

Standard - $ 45.00

Special* - $ 35.00

- none -

Conference

Standard - $ 95.00

Special* - $ 85.00

- none -

* Special registration: Friends of the Alliance, host church members, pastors and their accompanying spouse, senior citizens, children ages 8 through 14, and groups of 5 or more registering together. Children under 8 are free.

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 *