Author: Hani

				6	5	4	3	2	1	Please clearly print your name as you would like it to appear on your badge. / Anyone under the age of 18 MUST submit completed and signed Minor Participation Form prior to / receiving their Badge. / Place an X in the appropriate boxes for each listed person. / PLEASE PRINT CLEARLY.	Early Bird Deadline: / [DATE]
										Male
										Female
										Child (12 & under)
Clergy & Clergy Wives	Adults	Teens (Ages 13-19)	Children (Ages 4-12)							Teen (13-19)
										Adult
										Clergy/Clergy Wife
										Young Adults
										Order of St. Ignatius
										Antiochian Women
										Teen SOYO
										Early Bird Ticket Book	TICKET BOOK
										Regular Ticket Book
										TICKET BOOK EVENT 1	INDIVIDUAL EVENTS / (Included in Ticket Book)
										TICKET BOOK EVENT 2
										TICKET BOOK EVENT 3
										TICKET BOOK EVENT 4
										TICKET BOOK EVENT 5
										TICKET BOOK EVENT 6
										TICKET BOOK EVENT 7
										TICKET BOOK EVENT 8
										ADDITIONAL EVENT 1	ADDITIONAL EVENTS
										ADDITIONAL EVENT 2
										ADDITIONAL EVENT 3
										ADDITIONAL EVENT 4
										ADDITIONAL EVENT 5
										ADDITIONAL EVENT 6
										ADDITIONAL EVENT 7
										ADDITIONAL EVENT 8
										ADDITIONAL EVENT 9
										ADDITIONAL EVENT 10
										ADDITIONAL EVENT 11
										ADDITIONAL EVENT 12
										Processing Fee: (Required for all 12+ who do not purchase event tickets)	FEES
										Mandatory Registration Fee / (Ages 12 & older)
				$	$	$	$	$	$	Total

[Archdiocese Convention/[DIOCESE] Parish Life Conference]
Hosted by: [HOST PARISH]; [CITY, STATE] ~ [DATES]

Please mail completed form to:
[CONV/PLC NAME
[HOST PARISH NAME]
[HOST PARISH ADDRESS CSZ]
[PHONE]
[EMAIL]
[WEBSITE]

Registration Form

Register On-line: [WEBSITE]

Parish Name:	__________________________________
Parish City:	___________________ State: ________
Diocese:	___________________________________
Name:	___________________________________
Address:	___________________________________
City:	___________________________________
Phone:	___________________________________
Email:	___________________________________
State:	________ Zip Code: _____________

I acknowledge and understand that all charges and/or donations are non-refundable, as further set forth in the Privacy Statement at www.antiochianevents.org/privacy/XXX, and, unless I have enclosed a check with this form, I hereby authorize the Antiochian Archdiocese [[Diocese Name] Parish Life Conference], to charge the credit card below. All credit charges will appear on your credit card statement as Antiochian Archdiocese.

AMEX Discover MasterCard Visa Check/Cash
Credit Card Number:	_______________________________________________
Exp. Date	____________	CVV2	_____________
Amount (USD)	$___________ Date: ______________
Signature	___________________________________ / Signature required for all forms; Unsigned forms will not be processed!

We encourage everyone to pre-register. Some events may sell out and will not be available at the Conference.
Please complete the information above. Make check payable to: “[HOST PARISH]” and mail to above address. For all credit card payments the name and address on this form must match the name and address on the credit card billing statement. Online Registration available at:
[WEBSITE]