Please complete the form below
Name
Title
Address
City
State
Zip code
Country
Daytime Phone
Evening Phone
Email
Spouse Name (if attending)
Registration Fees
Pre-registration $35 per person
Onsite Registration $45 per person
(Youth Congress T-shirt $10)
On-site registration begins on Thursday, August 7th at 9:00 a.m. at
Faith Tabernacle United Pentecostal Church, 7100 West Oakland Park Blvd. Sunrise, FL 33313
Payment Type
Credit Card
Check or Cash
If paying by check, please mail completed form and payment to:
United Church of Jesus Christ
5150 Baltimore National Pike
Baltimore, MD 21229
