Pennsylvania Regional Assembly 2020

Virtual Event

November 21 & 29

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* 1. Will you be attending this event?

Yes

Other (please specify)

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* 2. How many guests will be joining you?

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* 3. Contact information

First Name

Last Name

Personal Address

Personal Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 4. What congregation do you attend?

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* 5. Number of Adult Participants I would like to register (including myself) at $20.20/each

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* 6. Number of Participants for Seminary/College/High School/Middle School Youth (Grade 6 and higher), including myself, I would like to register at $5.00/each

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* 7. Name of Participants other than myself that I am registering: (If they have a different email than you, please include their email so that we may forward them the link.)

10.

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* 8. To pay for registrations:

I will mail a check payable to the Christian Church in PA to 1402 Washington Ave, Parkersburg WV 26101

I will pay online at http://www.padisciples.net/ways-to-give.html
please put “Regional Assembly Registration Fee” in the comment field.

Question Title

* 9. To determine your registration cost:
$20.20 X (number of adults registered) + $5.00 X (number of students registered)=Total
Please put your calculated total owed here:

Pennsylvania Regional Assembly 2020

Virtual Event

Question Title

* 1. Will you be attending this event?

Question Title

* 2. How many guests will be joining you?

Question Title

* 3. Contact information

Question Title

* 4. What congregation do you attend?

Question Title

* 5. Number of Adult Participants I would like to register (including myself) at $20.20/each

Question Title

* 6. Number of Participants for Seminary/College/High School/Middle School Youth (Grade 6 and higher), including myself, I would like to register at $5.00/each

Question Title

* 7. Name of Participants other than myself that I am registering: (If they have a different email than you, please include their email so that we may forward them the link.)

Question Title

* 8. To pay for registrations:

Question Title

* 9. To determine your registration cost:$20.20 X (number of adults registered) + $5.00 X (number of students registered)=TotalPlease put your calculated total owed here:

* 9. To determine your registration cost:
$20.20 X (number of adults registered) + $5.00 X (number of students registered)=Total
Please put your calculated total owed here: