Registration Form for the First Annual
Florida Founders Conference
 
 
Name: ______________________________________
 
Address:_____________________________________
 
City: _________________ State: ____ Zip: ________
 
Day Phone: _____________________
 
Evening Phone: __________________
 
Church Affiliation: ____________________________
 
Check the following that apply:
 
___ Pastor ___ Elder ___ Student ____ Spouse ___ Other
 
___ Professor _________________________________
 
___ Special needs _____________________________
 
Check the following that apply:
 
____ Individual registration fee $60.00 (5 meals included) $75 after February 1
 
____ Spouse $25.00
 
____ Student $25 before February 1 $40 after February 1
 
Total Amount Enclosed: _________
 
 
Mail this registration form, along with your payment, to:
 
Florida Founders Conference
c/o Southside Baptist Church
10413 US 129
Live Oak, FL 32064
(386) 362-5239
 
(Make checks payable to Florida Founders)
 
NOTE: Childcare will be provided for the evening
meetings. Also, evening meetings are open to the public
at no cost.