PreRegistration

First Name:

Last Name:

Spouse's First (if applicable):

Spouse's Last (if applicable):

Will your spouse attend General Assembly?:

YesNo

Address:

Address 2:

City:

State:

Zip:

Email:

Home Phone:

Work Phone:

Is this your first General Assembly?:

YesNo

Member of (church name):

Church City:

Church State:

Are you on staff at church? If so, please type in your position:

Is your spouse on staff at church? If so, please type his/her position:

To help us better plan for this and future Assemblies, please respond to the following questions

Birthdate:

Gender:

MaleFemale

I am:

LaityExhibitorOrdained MinisterOrdained Deacon

If an exhibitor, please enter your company, school, or organization name:

Highest Degree:

Graduate of:

Year:

Laity: Please tell us how you serve in your local church: (Check all that apply):

Present Deacon ChairSunday School TeacherMissions EducatorCommittee Member

If Sunday School teacher, please enter age range:

If committee member, please specify which committee:

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