Please provide the following contact information:

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Choose one of the following options:

Hotel Single $210
Hotel Shared $165
Stay in Church $95
Staying Outside Consult $85

Choose one of the following options for registration fee (pay at the consultation):

Western Organisation $50
Western Faith Mission $30
Developing Country Worker $0

Your background (3 lines)

Topic of Presentation?

Presentation Material: Select any of the following options:

2 page presentation notes sent  5 min video    NTSC or PAL                           
CDROM power Point/Video Clip    

Enter the date of arrival :

-- dd/mm/yy

Enter the date of departure :

-- dd/mm/yy

Enter the time of arrival :

-- hh:mm:ss am/pm

Enter the time of departure :

-- hh:mm:ss am/pm

Arr and Dep Flight Numbers

Possible Contribution to Worship?