Thriving Churches Registration Form

Thriving Churches, Flourishing Communities

Thriving Churches Registration Form

Although conference participants come from a variety of religious traditions and backgrounds, all share a commitment to religious values and a respect for the rights of individuals.

Name

Salutation:

First Name: *

Middle Initial:

Last Name: *

Mailing Address

Address: *

City: *

State: *

Zip: *

Country: *

Phone: *

Email: *

Will you require lodging: *

Yes

The Acton Institute will provide meals to all participants for the duration of the conference, as well as lodging for out of town participants.

Personal Information

Marital Status: *

Sex: *

Date of Birth: *

Religious Affiliation: *

Country of Birth: *

Employment Information

Organization Name: *

Titles and Responsibilities: *

Future plans or goals in ministry: *

What you hope to gain from attending this program: *

Apply for Financial Assistance

Estimated Travel Expenses:

Your Contribution to Travel Expenses:

Total Requested Aid:

Explanation of Request:

Word verification: * Type the characters you see in this picture.

(verify using audio)

Type the characters you see in the picture above; if you can't read them, submit the form and a new image will be generated. Not case sensitive.

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Birth of Freedom Curriculum DVD and Study Guide (set)

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This DVD, hosted by Dave Stotts, designed for use with the Birth of Freedom Participant Guide, helps ground your faith through a powerful telling of how individual rights and freedom was born

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