World Missions
Centennial Celebration
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Registration Form
Centennial Celebration
Januar JJana uaaryyy 5-7, 55-7- , , 2010 - N2001010 -- NNasaassau,ssau, B BahamasBahhama as
Registration Costs:
Hotel registration is separate. To register at the hotel, go to the Web site,
$25, single
www.cogwm.org, or call toll-free 1-800-345-7492 to request a registration form.
$40, couple or family
First Name MI Last Name
Street Address or P.O. Box Number
City State Country Zip Code
E-mail Address
Daytime Phone Number Passport Number
Emergency Contact Person and Phone Number
Age: under 18 18-30 31-39 40-49 50-65 65 and over
Credentialed minister (Ministerial # _______________ )
Local Church Missions Representative
Layperson
Church Represented: _____________________________________________________________________
Names of other people in room: 1. ________________________ 2. ________________________
3.________________________
Any Special Needs? ______________________________________________________________________
Payment: Credit Card Check Money Order
________________ ______________________________________________ _________
Card Type Card Number Expiration
______________________________________________ ___________________
Signature Date
Please return completed form and payment to: Church of God World Missions, P.O. Box 8016, Cleveland, TN, USA 37320-8016.
For any questions, please call toll-free 1-800-345-7492 save our world 9
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