Lake Williamson Christian Center 17280 Lakeside Drive Carlinville IL 62626

March 31 - April 2, 2017


Group Registration

Contact Information


division
corps
corps address
corps city
corps state
corps zipcode
corps officer
rank
first
last

Group Members


Includes: Phil Tuttle's latest book “The Crucible”, six meals, lodging, towels and linens, workshops, recreation, coffee anytime, snacks and great fellowship!

Number of group members to be registered:

Member 1
First NameLast NameBirth Date (mm/dd/yyyy)LodgingFee
$0.00
Activities













Can you use a top bunk?

translation
trolley service needed from housing to meeting site


Dietary Restrictions





Other Restrictions
Agreements By checking this box I hereby give The Salvation Army permission to use photos of me involved in Refiner's Fire Territorial Men's Conference activities in their publications, promotions or other ministry materials.
Member 2
First NameLast NameBirth Date (mm/dd/yyyy)LodgingFee
$0.00
Activities













Can you use a top bunk?

translation
trolley service needed from housing to meeting site

Dietary Restrictions





Other Restrictions
Agreements By checking this box I hereby give The Salvation Army permission to use photos of me involved in Refiner's Fire Territorial Men's Conference activities in their publications, promotions or other ministry materials.
Member 3
First NameLast NameBirth Date (mm/dd/yyyy)LodgingFee
$0.00
Activities













Can you use a top bunk?

translation
trolley service needed from housing to meeting site
Dietary Restrictions





Other Restrictions
Agreements By checking this box I hereby give The Salvation Army permission to use photos of me involved in Refiner's Fire Territorial Men's Conference activities in their publications, promotions or other ministry materials.
Member 4
First NameLast NameBirth Date (mm/dd/yyyy)LodgingFee
$0.00
Activities













Can you use a top bunk?

translation
trolley service needed from housing to meeting site
Dietary Restrictions





Other Restrictions
Agreements By checking this box I hereby give The Salvation Army permission to use photos of me involved in Refiner's Fire Territorial Men's Conference activities in their publications, promotions or other ministry materials.
Member 5
First NameLast NameBirth Date (mm/dd/yyyy)LodgingFee
$0.00
Activities













Can you use a top bunk?

translation
trolley service needed from housing to meeting site
Dietary Restrictions





Other Restrictions
Agreements By checking this box I hereby give The Salvation Army permission to use photos of me involved in Refiner's Fire Territorial Men's Conference activities in their publications, promotions or other ministry materials.
Member 6
First NameLast NameBirth Date (mm/dd/yyyy)LodgingFee
$0.00
Activities













Can you use a top bunk?

translation
trolley service needed from housing to meeting site
Dietary Restrictions





Other Restrictions
Agreements By checking this box I hereby give The Salvation Army permission to use photos of me involved in Refiner's Fire Territorial Men's Conference activities in their publications, promotions or other ministry materials.
Member 7
First NameLast NameBirth Date (mm/dd/yyyy)LodgingFee
$0.00
Activities













Can you use a top bunk?

translation
trolley service needed from housing to meeting site
Dietary Restrictions





Other Restrictions
Agreements By checking this box I hereby give The Salvation Army permission to use photos of me involved in Refiner's Fire Territorial Men's Conference activities in their publications, promotions or other ministry materials.
Member 8
First NameLast NameBirth Date (mm/dd/yyyy)LodgingFee
$0.00
Activities













Can you use a top bunk?

translation
trolley service needed from housing to meeting site
Dietary Restrictions





Other Restrictions
Agreements By checking this box I hereby give The Salvation Army permission to use photos of me involved in Refiner's Fire Territorial Men's Conference activities in their publications, promotions or other ministry materials.
Member 9
First NameLast NameBirth Date (mm/dd/yyyy)LodgingFee
$0.00
Activities













Can you use a top bunk?

translation
trolley service needed from housing to meeting site
Dietary Restrictions





Other Restrictions
Agreements By checking this box I hereby give The Salvation Army permission to use photos of me involved in Refiner's Fire Territorial Men's Conference activities in their publications, promotions or other ministry materials.
Member 10
First NameLast NameBirth Date (mm/dd/yyyy)LodgingFee
$0.00
Activities













Can you use a top bunk?

translation
trolley service needed from housing to meeting site
Dietary Restrictions





Other Restrictions
Agreements By checking this box I hereby give The Salvation Army permission to use photos of me involved in Refiner's Fire Territorial Men's Conference activities in their publications, promotions or other ministry materials.

Fees


Total Due$0.00