women's conf registration

Friday, November 18^th and Saturday, November 19^th

Complete one registration form for each individual attending

First Name:
Last Name:
Address:
City:
State:
Zip:
Phone:
Email:
Church Affiliation:
Dietary Needs:

Women's Conference Payment

Conference Cost is: $65.00

(heavy hors d' oeuvres, breakfast & lunch)

Women's Conf 2005: $65.00:

(If paying by check DO NOT click on Add To Cart button see below)

To Pay by check: print registration (using your browser)

and mail to:

Antioch Baptist Church

6531 Little Ox Rd

Fairfax Station, VA 22039

Attn: Women's Retreat