HOUSE OF GOD, INC

93rd Annual General Convocation - Registration Form

Affiliation

I am a Member

I am a Guest. I am a Guest of:

I am a Guest and a Member of the Clergy. I am a Guest of:

Personal Information

Title:

First Name:

Last Name:

Address:

City:

State:

Zip:

Country:

Phone Number:

Email Address:

Church Name:

Church Address:

Pastor's Name:

Division:

Date of Arrival

Select Date:

Hotel Information

Hotel Name:

Hotel Address:

Other family members in attendance from the same household (16 years and up)

	Title	First Name	Last Name
Person #1:
Person #2:
Person #3:

Other family members in attendance from the same household (15 years and down)

	First Name	Last Name	Age
Person #1:
Person #2:
Person #3:

Sabbath Day Meal * * * NEW * * *

This year, Sabbath Day meals will be available to ALL convocation attendees for a cost. As of this date, the exact cost of the Sabbath Day meal has not been determined. To purchase a Sabbath Day meal, please complete the section below. Prior to the convocation, you will receive an email with more specific information regarding meal pricing and you will have an opportunity to confirm or modify your meal order.

How many Adult (ages 11 & up) Sabbath Day meals would you like to pre-order?

How many Child (ages 10 & under) Sabbath Day meals would you like to pre-order?

Please indicate any special needs (i.e., Diabetic Meal Ticket, Vegetarian, etc.)

Diabetic How many meals:

Vegetarian How many meals:

Other

Please confirm your email address:

Special Accommodations

Do you require special assistance during the convocation?

Interpreter

Medical Attention

Access to Dialysis Center

Other

Notice

Providing this information is voluntary and is not required to attend the 93rd Annual General Convocation. The information you furnish will be used for the purpose of producing reports on meeting attendance and overall convocation participation and ensuring meal service for those who pay. All reports are furnished to House of God, Inc., officials. All such reports will be in the form of aggregate totals and will not identify you in any way as an individual.

We would like to send you information on future House of God Convocations, National Meetings or other events/promotions. If you would like to receive information regarding future House of God conferences and activities using the name and address provided, please check the box below.

You may use my name and address to send information regarding House of God Convocations, National Meetings or other events/promotions to my e-mail address or postal address.