National Day of Prayer  ·  Thursday, May 4

Community Ministry & Prayer Summit Registration

PRINTER FRIENDLY VERSION

Use this form to register as many as 5 attendees per church/ministry to attend the whole day.     

All Registration Rates include tickets to the Oklahoma Centennial Concert ($6 value).

Church/Ministry:_______________________________ Address:___________________________________

City: ______________  Zip Code: _________ Website: _______________________ Phone: ______________

Contact Person: ___________________ Day Phone: ________________ Email: _______________________

Attending From Our Church/Ministry:
 

Name of 1^st Person:__________________________

Address: ___________________________________

City: _______________________ Zip: ____________

Email: _____________________________________

Phone: ________________________________­­­____

Cell Phone: _________________________________

Fax: _______________________________________

o Church/Min Staff  o Church/Min Volunteer

o Role at Church/Min.: ________________________

Name of 2^nd Person:__________________________

Address: ___________________________________

City: _______________________ Zip: ____________

Email: _____________________________________

Phone: ________________________________­­­____

Cell Phone: _________________________________

Fax: _______________________________________

o Church/Min Staff  o Church/Min Volunteer

o Role at Church/Min.: ________________________

Name of 3^rd  Person:_________________________

Address: ___________________________________

City: _______________________ Zip: ____________

Email: _____________________________________

Phone: ________________________________­­­____

Cell Phone: _________________________________

Fax: _______________________________________

o Church/Min Staff  o Church/Min Volunteer

o Role at Church/Min.: ________________________

Name of 4^th Person:__________________________

Address: ___________________________________

City: _______________________ Zip: ____________

Email: _____________________________________

Phone: ________________________________­­­____

Cell Phone: _________________________________

Fax: _______________________________________

o Church/Min Staff  o Church/Min Volunteer

Name of 5^th Person:__________________________

Address: ___________________________________

City: _______________________ Zip: ____________

Email: _____________________________________

Phone: ________________________________­­­____

Cell Phone: _________________________________

Fax: _______________________________________

o Church/Min Staff  o Church/Min Volunteer

o Role at Church/Min.: ________________________

Summit Registration Rates:

A. Individual: $25/person.

B. Three (3) or more from same church/ministry: $10/person (ex.: 3 for $30, 4 for $40. 5 for $50)

C. Rate for 2006 Cornerstone Partner churches & ministries:
$5/person (ex.1 for $5, 3 for $15, 5 for $25). Call Cornerstone to become a partner to get this special rate: 583-3670

Cost: ______ Persons x $______ (see rates above) =  $________

o Check (enclosed) made payable to Cornerstone.

o Credit Card: (circle)

Visa  MasterCard  Discover  AmEx


#: ______________________________  Exp. __/__/__
 

Name as appears on card:
 

 ___________________________________

  Signature:

 ___________________________________

Click on link above to pay using PayPal

Mail Registration To: Cornerstone Assistance Network, 1120 N Peoria, Tulsa 74106

Fax Registration To: 918-583-3097      Call In Registration To: 918-583-3670      

Email Registration To: cbeach@tulsacan.org