NERD Adult Registration 24'

Please fill out this form to complete your registration for the North East Diocese State Conference.

Reminder: Children have a separate registration form, please fill out the NE Diocese Youth Registration form if you would like to register for a child between the ages of 4 to 10. Thank you!

Personal Information:

Your Church Title

*

Please select one option.

Apostle Bishop Bishop-Elect Brother Deacon Deacon-In-Training District Elder Elder Elder-Elect Evangelist Lady Minister Minister-In-Training Missionary Mother Pastor Prophet Prophetess Sister Usher

Your Name

*

Your Email Address

*

This address will receive a confirmation email

Your Cell Phone Number

*

Your Home Address

*

Church Information:

Please fill out your full church name, abbreviations are not acceptable. Also include your pastor's full name and church title (ie. Bishop John Doe)

Church Name

*

Pastor's Name

*

Payment Information:

Registration Fee $40.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form to complete your registration for the North East Diocese State Conference.

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