Register for Shepherds' Conference 2012

Name: *

Surname: *

Contact Number: *

Email Address: *

Postal Address:

Where will you attend the Shepherds' Conference?: *

Pretoria

Polokwane

Cape Town

Please select one of the following: *

Pensioner/Student fee (Jhb/CT = R250, Pol = R150)

Normal fee (Jhb/CT = R450, Pol = R250)

How will you pay for your conference fee?: *

Electronic transfer

Direct deposit

Cheque (by post)

At the conference

I will send proof of payment via: *

Email

Fax

Post (cheque)

At the conference

Grace Fellowship - Pretoria