Wolverine State Congress of Christian Education On-Line Registration Form Dr. Addis Moore, Congress President Dr. Henry Fuller, Convention President

(Please complete all necessary information)
Church Name
Address
City
State
Zip Code
Church Phone (with area code)
Home Phone (with area code)
District
Your Name
Cell Phone (with area code)
E-Mail Address
Please check one: Pastor Moderator President Officer	Check appropriate boxes: Church District Personal

Delegate Names

Fill in the Payment Amount for each Meeting.
February, One-Day Workshop
Youth Banquet
April, One Day Workshop
Inspirational Session
Annual Session	Please Select Annual Session - $650 Individual - $25 / day Individual - $75 / 4 days
Scholarship Fund
Pastors/Wives Advance
Pastors Advance
October, One Day Workshop
Extended Session
Presidents Banquet
Church/Personal Registration
Other
Total Payment