Registration Form

Your Email:

Organization Name :

Organization Website :


Representative's Name :

Contact Name :

Phone:


Does your display require electricity? ($10)
yes
no

Would you like a nametag?
yes
no

Would you like to speak in a local church on Sunday?
yes
no

Will you be attending the Saturday morning breakfast?
yes
no

To be considered for a workshop, please send a title, a write-up describing your topic and the presenter's name by November 30th for placement in the magazine.

Scavenger Hunt - make up a question about your mission, & the answer:
Question:

Answer:

Message:
Sent at: 2012 02 04

I have read and agreed to the Exhibitors Agreement. 

Make your cheque payable to Jesus to the Nations.

Mail your registration to: 
DJ Poworoznyk
3836 Memorial Drive
Halifax, NS
B3K 6R6

Please enter the word you see in the image below: