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Registration

Personal Information
First Name*    
Last Name*  
Congregation*   
Select Appropriate Role (If you will be attending more than one track, select the one that is most appropriate to you).*  
Mailing Address*  
City*  
State*                    
Zip* 
Phone Number (work)*  
Phone Number (home)
Phone Number (cell)
Email 
Spouse Information
Will your spouse be attending? Yes No
If "Yes" then please fill out this section
Spouse First Name
Spouse Last Name
Children
Will you have children attending? Yes No
If "Yes" then please fill out the following information.
Will you need child care?		 Yes No
Will you have children in children's classes? (Ages 6-11) Yes No
Will you have children in the teen classes? (12-18) Yes No
How many children will be attending:
Child's Name
Child's Birthday (ex: dd/mm/yy)
Child's Name
Child's Birthday (ex: dd/mm/yy)
Child's Name
Child's Birthday (ex: dd/mm/yy)
Child's Name
Child's Birthday (ex: dd/mm/yy)
Child's Name
Child's Birthday (ex: dd/mm/yy)
Conference Attendance & Lodging
When do you plan on arriving?*  
When do you plan to leave?*  
How did you hear about PTP?*
If other please specify:
Will you need display space? Yes No
If yes, will you need commercial space? (selling anything is considered commercial space) Yes No
Will you be participating in the sermon swap?*  Yes No
Will you be staying at the Hotel of the Smokies?*
(This is for our information only. You are responsible for reservations with the Hotel) Call 877.325.9453		  Yes No
If no, where will you be staying?
Do you need lodging with a church member? No Free lodging is no longer available. Click here for more information on lodging solutions.
Will you need the free
breakfast?		 Yes No
Will you need the free lunch meals? Yes No
Will you need the free dinner meals? Yes No
Is this your first time to attend PTP?*  Yes No
How will you be paying?*
Why a fee?		 Mailing a Check
Credit Card
(Call Wes Blankenship at 256-435-9356 to pay with credit card)

Send in your check as soon as possible.

Please send checks to:

Jacksonville church of Christ
PO Box 520
Jacksonville, AL 36265

Materials Fee: Why a fee?
Registration is $185 (man)/ $135 (woman) per person. Children free.

Discounts:
First time to attend PTP: $125 (men) / $100 (women)
Spiritual Renewal Weekend (only): $75 (men) / $50 (women)

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