REGISTRATION FORM

IRON SHARPENS IRON CONFERENCE

Largo Community Church

Burke VA

Saturday, April 25, 2009

For more information - www,wacmm.org or 703.323.5040

Name__________________________________________________________________________________

Church or Group Name ___________________________________________________________________

Your Address ___________________________________________________________________________

City _________________________________________________________State ___________Zip________

Phon __________________________________________________________________________________

E-Mail _________________________________________________________________________________

CHECK APPROPRIATE BOXES

□ $39 Early Group Discount Rate (10 or more)

10 or more men registering together …………………………………………# of men ( ) x $39 per man = $ ______

Must be received by WACMM (with payment) by:

Sunday midnight, April 19, 2009 for the April 25, 2009 Conference @ Burkw Community Church

□ $48 Early Small Group or Individual Discount Rate (1-9) by Sunday midnight April 19, 2009

Less than 10 registering together……………………………………………...# of men ( ) x $48 per man = $ _____

Must be postmarked or received (with payment) by:

Sunday midnight, April 19, 2009 for April 25, 2009 Conference @ Burke Community Church

□ $55 Standard Rate (after above listed deadlines or at the door) ..........# of men (   ) x $55 per man = $_______

□ $20Discount Rate for Men Ages 13 and 22 ......................................# of men (   ) x $20 per man = $_______

□ $20Active Duty Military Rate Discount Rate .....................................# of men (   ) x $20 per man = $_______

□ $8 Lunch (optional but strongly recommended box lunch)................. # of men (   ) x $8 per man = $_______

Total Payment …. $ _______

THREE WAYS TO REGISTER:

□ FAX: this form to 703.323.5042 (Registration is only complete when payment is received)

□ MAIL: Check/money order enclosed with this form - payable to WACMM - Box 2753 - Springfield, VA 22152

□ INTERNET: use credit card for individual and group registrations at www.wacmm.org

CREDIT CARD: (billing address must be the same as the registration address) □ VISA □ MasterCard

Name on Card _____________________________________________________

Account # ____________ _____________ _______________ _______________ Expiration Date ______ ______

Cardholders Signature (Required) _________________________________________________________________

Note: THERE ARE NO REFUNDS ON REGISTRATIONS. Registrations are transferable. ISI Conferences will be held regardless of weather conditions.