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Congratulations on your decision to partner with WCA in hosting the Group Life Conference on October 24, 2009. Please complete all information and submit this application to be considered as an exclusive host site in your area. SIMULCAST HOST SITES WILL BE CONSIDERED ON A FIRST-COME, FIRST-SERVED BASIS.

1. Your Information

Your Information First Name
Last Name
Daytime Phone Number
Mobile Phone Number
Email Address

2. Church Information

Church Information Church Name:
Church Address:
Church City/Town:
Church State/Province:
Church ZIP/Postal Code:
Country:
Church Phone Number:

3. WCA Member Number:

WCA Member Number: