Register

Thank you for your interest in Leadership Weekend - March 9th & 10th, 2012. We are very excited to have you be a part of this event. To register, please fill out the form below. If you have any questions, please email Scott Jester at sjester@gracegathering.com.

Name: *

Name of Spouse if attending:

Address: *

Phone: *

E-mail: *

What church are you from: *

Attender or Leadership role: *

Attender

Leadership Role

If leadership, what role:

Number of children attending (birth to 5th grade):

Name and age of each child attending:

Do any of your children have food allergies:

Yes

If so, please list:

Are you coming with others within your community (if so who):

What is the name of your mission community or house church if applicable:

You will be assigned someone from the prayer and prophetic team that will pray for you ahead of time and during the event. Please list some prayer requests specific to your mission community or group:

How did you hear about the leadership weekend:

Payment Options

How many adults at $16 each (includes dinner, breakfast, lunch, training): *

How many children at $7 each (includes dinner, breakfast, lunch, full children's program): *

How would you like to pay: *

Any additional comments: