JONATHAN CLARK'S MINISTRIES

REGISTRATION  FORM 

 REGISTRATION FORM:

 JONATHAN CLARK'S MINISRTRIES

AMERICA GREATIST WORLDWIDE REVIVAL In MIAMI, FL 2013

( CALLING THE NATION OF AMERICA )

May 13- 19, 2013  

Early Bird Special :

REGISTRATION FEE:   $ 112.PER PERSON  20 & UP

 PER PERSON

12 & UNDER   free- please register  online

 

DATE: ________________                                             PRICE:  _______________

 

NAME _______________________________

ADDRESS: ____________________________

CITY: _____________________   STATE: _________________   ZIP CODE:  _________

tELEPHONE NUMBER    HM: ___________________        CELL: ___________________    WK________________

email: ______________________________

 

Name of Church __________________________________

 

Address:_________________________________

 

City: ______________________________     State: ______________________   Zip Code: ____________________________

 

 Telephone Number: ___________________________________

 

Name of Pastor: ____________________________________               Email: __________________________________

 

How did You hear about the meeting:

 Radio station and what area ___________________________

friend  ,  word of mouth ,  neighbor

 website :  Please List which one  -   

search engine  google, yahoo, hotmail, eventbrite   ( please Circle one )

Would You like to be put on mailing list for future events?  Yes or No

How many will be Traveling in y our party? ______________

 

  HOW WILL YOU BE TRAVELING BY ?

BUS,  PLANE ,  CAR ,  TRAIN   ( PLEASE CIRCLE ONE)