Prophetic Blast 2019 Conference Registration Form with Payment

Conference Registration

Please Register for the Conference by filling out the form below, specify the expected number and names joining the conference.
Full Name*

First Name Last Name
E-mail*
Phone Number*

Area Code Phone Number
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Church Affliation
Please give us your Pastor's name and the church you are attending and are a member.
Number of Adults Attending*
Registration is $50 per adult (ages 19-up), after 10/20/19 registration is $60 per adult.
Names of Adults Attending*
Number of teens Attending*
Registration is $10 per teen (ages 13-18), after 10/20/19 registration remains $10 for teens ONLY!
Names and Ages of Teens Attending
Number of Children Attending*
Registration is free for children (ages 5-12), however all children must be accompanied by an event/paid in full attending adult. We have NO child care...
Names and Ages of Children Attending
Payments are processed through PayPal (convenience fee plus registration amount). You may pay using an existing PayPal account, or any major credit card/debit card.

Payment is nonrefundable.

Daily rate not available
Prophetic Blast Payment
prevnext( X )
Adult Registration plus convenience fee$52.00

Quantity
Item subtotal:$0.00

Teen Registration plus convenience fee$10.00

Quantity

Total $0.00
loading smart payment buttons...

The payment is ready! It will be completed once you submit the form.
Should be Empty: