Western District Ladies Conference
Far Above Rubies
February 23-25, 2012

Registration Form
Name: ____________________________________________________________
Address: ___________________________________________________________
City: ________________________ State: ______ Zip: _______________________
Email: _____________________________________________________________
Church: ____________________________________________________________
Pastor: ____________________________________________________________
______________________________________________________________________________________________________________________________________
2012 Ladies Conference
Credit Card Registration
Please add $_________ to my credit card. Visa: ____ MC: ____
Account Number: __________________________ Expiration Date: ____________
Name on Card: ______________________________________________________
Address: ___________________________________________________________
City: _________________________ State: ________ Zip: ____________________
Phone: ____________________________________________________________
Signature: _____________________________ Date: _______________________
Please copy, fill in and send your non-refundable registration
form to the registrar below
Make checks payable to:
Western District Ladies Ministries
Shelley Moore
395 Furlong Road
Willits, CA 95490
mendoupc@sbcglobal.net
Please check if it applies:
____Pastor’s Wife
____ Minister’s Wife