Individual Registration Form Liberty Missionary Baptist Church

Gulf Coast Men’s Empowerment Conference
Individual Registration Form
July 31 – August 2, 2014
Liberty Missionary Baptist Church
1759 Dr. Martin Luther King Jr. Avenue
Mobile, Alabama 36617
Phone (251) 479-4460
Rev. Dr. Clyde Maye, Jr. Pastor
Conference information: www.libertymbchurch.org
Full Name: _______________________________ (First name for badge)_______________________
Church /Organization: ________________________________________________________________
Mailing Address:_____________________________________________________________________
City: __________________________________________ State/Province: ______________________
Zip/Postal Code: ______________________ Cellphone: (______)____________________________
Email: ____________________________________________________________________________
CONFERENCE FEES
1. Registration Fees
Includes all events and Networking, 3 meals over the course of the Conference.
POSTMARKED & PAID
PLEASE CHECK APPROPRIATE REGISTRATION FEE: BEFORE/ON JUNE 31
AFTER JUNE 31
Individual Rates
Men 18 & Over
18 & Under
 $12
 $5
 $15
 $7
Cancellations/Changes and Refunds: There will be NO REFUNDS offered
for missed sessions, late arrivals, and early departures. If rescheduling is
necessary due to inclement weather all funds will be applied to rescheduled
date.
PAYMENT METHOD:
Check or Money Order payable to: Liberty Mission Baptist Church.
There will be a $25.00 fee charged on checks returned by the bank due to
insufficient funds. No Check will be received for payment after
July 13, 2014.
After July 13, 2014 all payment will only be received in CASH ONLY.
Registration confirmation/receipt and further information will be mailed.
Please check appropriate box:  Check
Mail form and payment to:
 Money Order
Liberty Missionary Baptist Church
1759 Dr. Martin Luther King Jr. Avenue
Mobile, Alabama 36617
(251) 479-4460
Attn. Gulf Coast Men’s Empowerment
Conference
For More Information Email: Cicone@ciconeprince.com
Gulf Coast Men’s Empowerment Conference
Group Registration Form
July 31 – August 2, 2014
Liberty Missionary Baptist Church
1759 Dr. Martin Luther King Jr. Avenue
Mobile, Alabama 36617
Phone (251) 479-4460
Rev. Dr. Clyde Maye, Jr. Pastor
Conference information: www.libertymbchurch.org
Full Group POC Name: __________________________ (First name for badge)___________________
Church /Organization: ________________________________________________________________
Mailing Address:_____________________________________________________________________
City: __________________________________________ State/Province: ______________________
Zip/Postal Code: ______________________ Cellphone: (______)____________________________
Email: ____________________________________________________________________________
CONFERENCE FEES
1. Registration Fees
Includes all events and Networking, 3 meals over the course of the Conference.
POSTMARKED & PAID
PLEASE CHECK APPROPRIATE REGISTRATION FEE: BEFORE/ON JUNE 31
Group Rates
Groups of 10 or More
 $10
AFTER JUNE 31
 $12
Add Names for Group Members on Attached Sheet.
Cancellations/Changes and Refunds: There will be NO REFUNDS offered
for missed sessions, late arrivals, and early departures. If rescheduling is
necessary due to inclement weather all funds will be applied to rescheduled
date.
PAYMENT METHOD:
Check or Money Order payable to: Liberty Mission Baptist Church.
There will be a $25.00 fee charged on checks returned by the bank due to
insufficient funds. No Check will be received for payment after
July 13, 2014.
After July 13, 2014 all payment will only be received in CASH ONLY.
Registration confirmation/receipt and further information will be mailed.
Please check appropriate box:  Check
Mail form and payment to:
 Money Order
Liberty Missionary Baptist Church
1759 Dr. Martin Luther King Jr. Avenue
Mobile, Alabama 36617
(251) 479-4460
Attn. Gulf Coast Men’s Empowerment
Conference
For More Information Email: Cicone@ciconeprince.com
Gulf Coast Men’s Empowerment Conference
Group Registration Form
July 31 – August 2, 2014
Liberty Missionary Baptist Church
1759 Dr. Martin Luther King Jr. Avenue
Mobile, Alabama 36617
Phone (251) 479-4460
Rev. Dr. Clyde Maye, Jr. Pastor
1. ______________________________________________
2. ______________________________________________
3. ______________________________________________
4. ______________________________________________
5. ______________________________________________
6. ______________________________________________
7. ______________________________________________
8. ______________________________________________
9. ______________________________________________
10.
____________________________________________
11.
____________________________________________
12.
____________________________________________
13.
____________________________________________
14.
____________________________________________
15.
____________________________________________
Make copies and use additional sheets if necessary.
For More Information Email: Cicone@ciconeprince.com