Online Registration --- Deadline for registering is Jan 25, 2010.

Name:

Address:

City: State: Zip:

Phone: Email:

Home Church: City:

I will be attending:

The Summit: Friday Group size:

The Summit: Saturday Group size:

Friday Dinner: $10.00 Group size:

Saturday Breakfast: $5.00 Group size:

Meal costs to be paid at the Summit

Seating is limited to the first 1000 to register.