*Name(s)
First and Last

*Church

Address

City/Town

Postal Code

*E-mail

Dietary restrictions/allergies

*Are You a Delegate? No Yes

Delegate Name(s)

Do You Require Child Care? No Yes
For Delegates only - will only be offered on Saturday

Ages of Children
Please list the names and ages of those children that will need child care

*Method of Payment Pay Now with Credit Card or PayPal I'll send a cheque
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