Mount Vernon Baptist Church
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Whole Hearted Surrender:
Women's Conference
Basic Information
First Name
Last Name
Email
Phone Number
Address
Apartment, suite, etc.
City
State
Zip/Postal Code
Age Group
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65+
Church Information
Do you regularly attend a church?
Yes
No
What Church do you attend?
Conference Details
How did you hear about this conference?
Friend
Church Announcement
Facebook
Instagram
Flyer
Website
Other
If other, please explain:
Lunch Information
Allergies
Do you need a Gluten Free option?
Yes
No
Please note any other dietary restrictions.
Accessibility & Special Needs
Do you have mobility needs or require accessibility accommodations?
Yes
No
How can we best serve you?
Do you require reserved seating
Yes
No
Is there anything we can do to help make your conference experience more comfortable?
Emergency Contact
First Name
Last Name
Phone Number
Relationship
Prayer & Ministry
Is there a specific prayer request you would like our prayer team to pray before the conference?
Conference Policies
I understand that photographs and video may be taken during the conference and may be used for ministry purposes.
Yes, I understand
I have completed registration information accurately to the best of my ability.
Yes
I understand the conference details.
Yes, I understand
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