Spring Conference Registration

Please complete the following fields. All payments are non-refundable.

First Name:
Last Name:
Address:
City:
State:
Zip:
Phone:
Email:
Church name:
District:	Central Ohio
	East Ohio
	Eastern Kentucky
	North Central Ohio
	Northwestern Ohio
	Southwestern Ohio
	West Virginia North
	West Virginia South
	I attend a church of another denomination.
	I attend a Church of the Nazarene from another area.
	Other
Plan 1: Fri and Sat Sessions	x $35 = $
Plan 2: Fri or Sat Session (Single day registration)	x $20 = $
Plan 3: Fri and Sat (Student Rate: Ages 13-25)	x $20 = $
Grand Total:	$
Please list additional guests' full names and addresses if more than 1 attending:
Pay by:	Credit Card Online Check Online Check by Mail
Security Check Please type both words separated by a space below.