Please Check One:

Sr Pastor Associate Minister Pastor's Spouse Licensed Evangelist
Lay Member Youth 10-17+ Senior 65+ Physically Handicapped

          Registration Fee Covers:  Preferred Seating, Souvenirs, Reception, Sessions, Workshops, Saturday Continental Breakfast                                          

  T-Shirt: $15.00   (Size: - S M L 1x 2x 3x 2x & 3x - add $3 to your total)

Saturday Child Care will be provided for: $5.00 for one child/ $2.00 for each add'l child (Ages 3 - 9 only) 

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Registrant Information

Please provide the following contact information to be used for registering and payment: *Required.

*First Name
*Last Name	Title  Dr. Miss Mr. Mrs. Ms. Prof. Rev.
*Street Address
Address (cont.)
*City
*State/Province	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *Zip/Postal Code
Church Name
Work Phone
*Home Phone
FAX
*E-mail	(Confirmation Notice)

Registration Fee Schedule:

Group & Senior Discount: $5.00 off current rate through September 30.

Note! One Day Registration - $25. per day if seating is available. 

Registration is not complete until payment is receive!

Please Note! Late Registration does not guarantee souvenirs. Registrations are Non-Transferable / Non-Refundable. Limited T-Shirts Available On-Site.

BILLING METHOD

Registration Fee

25.00 35.00 40.00 45.00 50.00 60.00   +  Any add'l cost  =  *Total Cost   $

Please calculate your total here.

I prefer to pay by:

Check By Mail

If ordering by mail, print your Registration Form and mail along with your payment. Don't forget to click the "Submit Button" below. Make checks payable to Mt. Olivet Baptist Church **$25 Processing Fee Due on ALL Returned Checks.

Pay On Site or By Phone  

If paying at location or by phone, submit your Registration Form by clicking on the button below and you will be given instructions.