PROPHETIC FIRE CONFERENCE 2010

REGISTRATION FORM

 

Cost - R200 per delegate. (Register before 5 September 2010 and get a 10% Early Bird registration discount)* Registration will be confirmed ONLY after payment  is received! You will then be allocated an official registration number and sent an official letter confirming your booking.

 Account Holder:  Logos Prophetic Ministries
 Bank:  Nedbank (Randburg)
 Account type:   Current
 A/c no.:   1984588702
 Branch code:  198405
 Swift code:  NEDSZAJJ

Please fax to +27 (0)867433187 or email payment confirmation to admin@sivamoodley.com 

* To qualify for Early Bird discount, you must register and have made payment before 5 September 2010.

Name Title
Surname Email
Address Confirm Email
Additional Delegates in your group. (each must register individually but will be linked to you) Country
Please assist me in finding accommodation YES      NO
Add me to your mailing list YES      NO Mobile Phone
Church Telephone