Prophetic Conference Online Registration Name*Registration for our 2025 Conference is open. As good stewards of the financial resources the Lord provides, we do NOT mail tickets. The email you receive from PayPal is your receipt. Your packet will be ready at the door when you arrive at the conference. First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* What is your Church's name and/or your regional affiliation?Do you or anyone attending with you have Special Needs?* No Yes Please briefly list the Name of the Person & their Special Need(s.)*Are you registering any other adults now?* No Yes Please provide accurate information for each person you are registering. Thank you. Who are you Registering?* Myself only Myself & Guest How many adults are you registering?*Name of 1st Guest* First Last Address of 1st Guest* Street Address City State / Province / Region ZIP / Postal Code Phone of 1st Guest*Email of 1st Guest Name of 2nd Guest* First Last Address of 2nd Guest* Street Address City State / Province / Region ZIP / Postal Code Phone of 2nd Guest*Email of 2nd Guest Name of 3rd Guest* First Last Address of 3rd Guest* Street Address City State / Province / Region ZIP / Postal Code Phone of 3rd Guest*Email of 3rd Guest Name of 4th Guest* First Last Address of 4th Guest* Street Address City State / Province / Region ZIP / Postal Code Phone of 4th Guest*Email of 4th Guest Daycare Registration is open through 9/17/2025.*No, I do not need DaycareYes, I need DaycareBirth through Kindergarten $10 for 1 child $20 for 2 or more childrenHow Many Children Are you Registering?* 1 Child 2 Children 3 Children 4 Children 5 Children 6 Children Birth through 1st gradeFirst child's name and age*Second child's name and age*Third child's name and age*Fourth child's name and age*Fifth child's name and age*Sixth child's name and age*Kidzz Conference Registration is open through 9/17/2025*No, I don't need Kidzz AcademyYes, I do need Kidzz AcademyThird ChoiceFirst through Sixth GradesHow Many Elementary School Children Are You Registering? 1 Kidzz Conference Child 2 Kidzz Conference Children 3 Kidzz Conference Children 4 Kidzz Conference Children 5 Kidzz Conference Children 6 Kidzz Conference Children For children in 1st grade & upFirst elementary school child's name and grade*Second elementary school child's name and grade*Third elementary school child's name and grade*Fourth elementary school child's name and grade*Fifth elementary school child's name and grade*Sixth elementary school child's name and grade*Vendor or Exhibitor registration is open through 9/17/2025. No Yes (for example, do you sell Jewelry, clothing, vitamins, music, health coaching, etc) We will send you an Information Packet to be filled out & returned for approval.Are you in full-time ministry? No Yes Name of Ministry*Address of Ministry* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone number of ministry*Pre-purchase the entire conference audio recordings is open. Yes, MP3 – $25.00 before 9/21/2025 Yes, CD – $35.00 before 9/21/2025 No thank you Price includes Free Shipping and Handling! Pre-purchasing price saves $10 over purchasing at or after the conference.Total $0.00 Proceed to PayPal to RegisterYOU MAY PAY WITH YOUR CREDIT/DEBIT CARD AT PAYPAL. YOU DO NOT NEED A PAYPAL ACCOUNT. As good stewards of the financial resources the Lord provides, we do NOT mail tickets. The email you receive from PayPal is your receipt. Your packet will be ready at the door when you arrive at the conference. If you have any questions or need help with this form please contact the church office at 970-663-(LIFE)5433.Total $0.00 Total $0.00 NameThis field is for validation purposes and should be left unchanged. Daytime Childcare RegistrationBirth – Kindergarten requires advanced registration of $10 for 1, $20 for 2 or more. This form must be completed when you register by 9/20/2023. Evening Childcare is by donation.
