Appalachian Conference IPHC - Ministers Summit Registration Form

Appalachian Conference

2023 Ministers' Summit

Registration Form

First Name

Last Name

Is spouse attending?
Yes
No

Spouse's First Name

Last Name

Address 1

Address 2

Country

City

State

Zip/Postal Code

Hotel Room Selection
Regular Room
Handicap Room

Do you have any special requirements?

Phone Number

Email Address

Registration must be in the Conference Office by January 20, 2023. Full payment must accompany registration form. Registration includes: 2 Nights' Lodging, Deluxe Continental Breakfast (Thursday & Friday) and Dinner on Wednesday Evening For Questions call: 540-674-4131, Ext. 201 or email: dmsecretary1@aol.com