EGP Registration Form

Encountering God's Presence Women's Conference Registration Form
Full Name*

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Date*

MonthDayYear
Conference Lunch: Please list any special needs*
Payment Method*

CheckMoney OrderPayPalCashCredit/Debit CardSquare-Up
Talent Release*

I hereby assign and grant Wellsprings Counseling Services, LLC the right and permission to use, publish and distribute any and all photographs/film/video tapes/electronic representations and/or sound recordings made of me by Wellsprings Counseling Services, LLC or provided by me to Wellsprings Counseling Services, LLC and I hereby release Wellsprings Counseling Services, LLC from any and all liability from such use and publication. I specifically waive any right of any kind including compensation I may have for any of the foregoing.
Cancellations/Changes and Refunds: Payments for no shows, missed meals, late arrivals, and early departures will NOT be refunded. No cash refunds, but substitutions are allowed at no additional charge.

Payment Method: Check, Credit/Debit Card or Money Order must be in U.S. funds payable to Wellsprings Counseling Services, LLC with 2019 Women's Conference denoted in the memo. There will be a $35.00 fee charged on checks returned by the financial institution due to insufficient funds. Registration confirmation will be mailed with your conference ticket.
Date*

MonthDayYear
Date
Should be Empty:

Encountering God's Presence Women's Conference Registration Form