Please go back and fill in the entire form.
This is a form submission for the EIM Conference via the web.

A new application is being submitted by: #form.title# #form.Name#

There Contact information is as follows:
Address: #form.address#
City: #form.city#
State: #form.state#
ZipCode: #form.zipcode#
Their country location is: #form.country#
Contact phone number: #form.phone#
Email Address: #form.emailaddress#
Their Church Affiliation: #form.churchaffiliation#

#form.name# will be attending the following sessions:
#form.attendsession#

The following children will be attending also:
#form.Child1# #form.Child1Age#
#form.Child2# #form.Child2Age#
#form.Child3# #form.Child3Age#
Membership Status:
#form.AlreadyAMember#


Thank you #form.name#!

Thank your for your registering for the EIM Conference, September 25-26, 2008. You will recieve a confirmation email.
If you would like to purchase your ticket for the Pastors Luncheon w/ Drs. James and Stacia Pierce please
Click Here




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EIM Conference September 24-25, 2009
Registration Form
Please complete the form below to register for this FREE conference.

Click here for group registration.
Name * Title   *
Address * Evening Phone # *  
City * State *
Zip Code * Country *
E-mail Address *      Church Affiliation   *

* You must fill in all answers or this form will not submit.

List each session that you will attend: * All Sessions
Thursday AM Thursday PM

Friday AM Friday-Pastors Luncheon (Senior Pastors & Spouses only)
Friday PM
Friday Reception (Senior Pastors & Spouses only) *

My child(ren) will attend the childcare for ages 0-9. PM sessions only. *
Child 1. age
Child 2. age
Child 3. age
Child 4. age

Membership:
I am already and EIM network member.

 
Yes, I want to join EIM, please rush me an information packet.
No thanks.

 
 

 


        

 


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Conference
Details

 






 


 
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