Intimacy with God Registration

Intimacy with God beginning 2 February 2012

Course Fee $50.00 - Registrations Close 30 January 2012
The School requires the $50 non refundable course fee at time of registration to secure your place.

Payment options will be given after this form is submitted.
Options include Paypal (Credit Card or Account), Cheque or Direct Deposit.


Attendee Information (*Denotes Required Field)


Title: *
Invalid Input
Given Name: *
Please supply your given name.
Surname: *
Please supply your surname.
Address: *
Please enter your street address.
Suburb/Town: *
Please supply a suburb or town.
State: *
Please supply your state name.
Postcode: *
Please supply your postcode.
Country:
Invalid Input
Email Address: *
Please enter a valid email address.
Contact Phone No: *
Please supply us with a contact phone number.
Your Church Name: *
Please supply us the name of the church you attend.
Any medical conditions/allergies we should be aware of:
Invalid Input
Special Dietary Requirements:
Invalid Input
Additional Comments:
Invalid Input
The $50 non refundable fee at time of registration is required to secure your place. Balance is payable by 30th January 2012

DISCLAMER: Prices are per person unless otherwise stated. Please note that all bookings are subject to availability at time of receipt. Life House Conference recommends that you confirm your registration with our office prior to booking any flights/accommodation to attend conference. The Life House Conference does not accept any responsibility for any losses incurred, including but not limited to, flights and/or accommodation booked for the conference.



View our Privacy Policy here (pdf)