ANCO Fall Retreat Registration Survey

Please enter your registration information on this page.

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1. Registration Information:

Registration Information: Name:
Address:
City:
State:
Zip:

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2. May we contact you via email regarding your ANCO Fall Retreat registration and related event updates?

May we contact you via email regarding your ANCO Fall Retreat registration and related event updates? No, I do not wish to be contacted via email regarding my ANCO Fall Retreat registration and related event updates.

Yes, please contact me via email regarding my ANCO Fall Retreat registration and related event updates. (please provide your email address)

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3. Please choose a registration option:

Please choose a registration option: Option 1 includes: overnight stay, Friday night fellowship, main session and reception, Saturday breakfast buffet, all teaching times and sessions and lunch buffet. *** If selecting this option please answer questions #3 - #4 below.

Option 2 includes: NO overnight stay, Friday night fellowship, main session and reception, Saturday breakfast buffet, all teaching times and sessions and lunch buffet. *** $40.00 per person ***

Option 3 includes: Only Friday night fellowship, main session and reception. *** $15.00 per person ***

Option 4 includes: Only Saturday breakfast buffet, Saturday teaching times and sessions and lunch buffet. *** $25.00 per person ***

4. If you selected Registration Option #1, please indicate the number of people rooming with you:

If you selected Registration Option #1, please indicate the number of people rooming with you: 1 person = $115.00

2 people = $75.00 per person

3 people = $60.00 per person

4 people = $55.00 per person

5. If you will be staying overnight and sharing a room with someone else please provide the name(s) of those staying with you.

If you will be staying overnight and sharing a room with someone else please provide the name(s) of those staying with you. Roommate #1:
Roommate #2:
Roommate #3:

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6. Please indicate how you plan to pay for your registration:

Please indicate how you plan to pay for your registration: #1 - Pay at registration table on Sunday mornings

#2 - Mail registration check to Randy Brown (ANCO Admin Assistant). See next page for additional details.

#3 - Pay online using ANCO's PayPal account. See next page for additional details.

#4 - Other (please specify)

Payment Instructions:

If paying by mail, please make your check payable to All Nations Church with the memo field left blank. Mail your check and a printed copy of your registration confirmation to:

Randy Brown
4794 Ohio St
Omaha, NE 68104

If paying online using ANCO's PayPal account, please visit:
http://www.ancomaha.org/cal/OnlineGiving.html

Randy Brown will have a list of people who indicated they will be paying online. Please use the same name on your registration form for your PayPal payment so that your payment is properly applied. A PayPal account is not required to make this online payment.

ANCO Fall Retreat Registration
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ANCO 2010 Fall Retreat Registration

*
1. Registration Information:

*
2. May we contact you via email regarding your ANCO Fall Retreat registration and related event updates?

*
3. Please choose a registration option:

4. If you selected Registration Option #1, please indicate the number of people rooming with you:

5. If you will be staying overnight and sharing a room with someone else please provide the name(s) of those staying with you.

*
6. Please indicate how you plan to pay for your registration:

ANCO Fall Retreat RegistrationExit this survey

ANCO 2010 Fall Retreat Registration

*1. Registration Information:

*2. May we contact you via email regarding your ANCO Fall Retreat registration and related event updates?

*3. Please choose a registration option:

4. If you selected Registration Option #1, please indicate the number of people rooming with you:

5. If you will be staying overnight and sharing a room with someone else please provide the name(s) of those staying with you.

*6. Please indicate how you plan to pay for your registration:

ANCO Fall Retreat Registration
Exit this survey

*
1. Registration Information:

*
2. May we contact you via email regarding your ANCO Fall Retreat registration and related event updates?

*
3. Please choose a registration option:

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6. Please indicate how you plan to pay for your registration: