Buckeye State  Sword Ladies' Jubilee
May 1-3, 2008
Urbana, OH

Do you plan to attend the Thursday afternoon opening reception for
speakers and guests?  Yes      No
(The reception begins at 5:45pm. The first service begins at 6:45pm.)

Personal Information

First Name

  

Last Name

  
Address 1  
Address 2  
City  
State  
Zip Code  
List any additional address information  
Email Address  
Home Phone Number  

Church Information

Pastor's Name  
Church  
Church Address  
City  
State  
Zip Code  
List any additional address information  
Church Phone Number  

Additional Registrants
 For multiple registrations to be paid at the same time
 please list all names in the box below. 
(ex.  1. Sally Smith, 2. Sally Jones, 3. Sally Brown... etc.)

 

Payment Information
For multiple registrations you will receive one free attendee
for every 10 paid registrants!!

If you have 9 paid registrants, your charge would be:
9 x $39.95 = $359.55

If you have 10 paid registrants, your charge would be:
10 x $39.95 = $399.50 and you would receive an 11th admission free of charge.

(Please indicate the appropriate amount to charge in the space below. Please note that the amount charged must match for the number of registrants listed.  Partial payments are not accepted.)
 

Credit Card Information
 
Credit Card Type  
Name On Credit Card  
Credit Card Number  
Expiration Date   (mm/yy)
Amount to Charge*