East Coast Christian Women Conference 2010 Registration Form
August 14, 2010

Date:

Name:

Address:

City: State: Zip:

Phone Number:

Church Affiliation:

Will be attending: Women's Conference Men's Luncheon Young Ladies Session (12-18)

** CHILDCARE PROVIDED; DONATIONS ACCEPTED PLEASE**

Is Child Care Needed? Yes No

If yes, number of children:

Age(s):

Gender: Male Female