Annual Conference Registration

If paying by check, please select "Print" to print out this form and mail it in with your check.

If you are going to pay online, please fill out the form and then select "Submit Form". Your form will be submitted and you will be taken to the online payment.

{Prefix value} {Other value} Other Name: {name value}

Address: {address value}

City: {city value} State: {state value} Zip code: {zip_code value}

Telephone: {phone value}

E-mail: {email value}

Cell: {cell value}

Business Information

Occupation: {occupation value}

Affilation: {affillation value}

{same_address value} My business address is the same as the above

Address: {b_address value}

City: {b_city value} State: {b_state value} Zip code: {b_zip value}

Phone: {b_phone value}

Select one track: {course value}

If you selected "Advanced", please give a brief statement identifying any previous introduction to the American Christian Philosophy of History, Government, and Education.
{Statement value}

{SUBMIT} {RESET} {REQUIRED_STAR}

Early Registration (Paid by December 31, 2006)    $110.00*
Early Registration (Paid by March 1, 2007)    $115.00*
Final Registration (Paid after March 1, 2007)    $125.00*

* $40.00 of Registration Fee is non-refundable. The balance will be refunded if Pilgrim Institute is notified 72 hours prior to Conference.