Keeper Of Fire Registration -

Are you registering prior to April 26, 2025? *

Yes
No

(Early Registration) How Many People Are You Registering At This Time? *

Registration = $35/person | Pastors & Wives Attend Free & Do Not Require Registration

(Late Registration) How Many People Are You Registering At This Time? (copy) *

Registration = $45/person | Pastors & Wives Attend Free & Do Not Require Registration

Primary Registrant

Name *

First

Last

Phone *

Email *

Address *

Address Line 1

City

State

Zip Code

Please List Additional Registrants (If Necessary)

Person #2's Name

First

Last

Person #3's Name

First

Last

Person #4's Name

First

Last

Person #5's Name

First

Last

Person #6's Name

First

Last

Person #7's Name

First

Last

Person #8's Name

First

Last

Person #9's Name

First

Last

Person #10's Name

First

Last

Pastor's Name *

Church Name *

Total *

$0.00

Credit Card Information *

Card

Name on Card