Welcome!

    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

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