KidsQuest Online Registration Form

All fields must be completed to submit the form.

Select a location and provide your registration information below:

June 14, 2008
       KidzMax Live (9 AM - Noon)
       Character Connex (12:30 PM - 3:30 PM)
       Register and pay at the Character Connex Store
       Christ's Chapel Assembly of God
       Erlanger, KY
       Brochure

Team Leader

Church

Mailing Address

City

State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other/Outside USA

ZIP

Office Phone Number

Home Phone Number

Fax Number

E-Mail Address:

Number of additional people from your church attending the Regional Training event:

Will your spouse be attending?

If so, please enter his/her name