2019 5-Day Academy

*First Name
*Last Name
Address 1
*City
*State
*Zip
*Phone
*Email
Cell Phone:
*Gender
Male
Female
*First time attender:
Yes
No
*Please select one:
Lay
Clergy
Church Staff
Continuing Education Units

Three (3) CEU’s are available from the FL Conference (FREE) and/or from the GBOD for a fee of $15. A GBOD form will be available for you when you arrive at the Academy.

FL Conference
GBOD $15.00 - payable at check in
*Local Church Affiliation:
Lodging Options:
None
First Floor
Second Floor
Handicapped
Special Housing Needs:

If you have chosen a First Floor or Handicapped room please list medical need:

*Dietary Needs/Options:
Regular
Diabetic
Vegetarian (no meat)
Gluten Free
List any food allergies:
*Registration choices:
Single Occupancy ($650)
Double Occupancy ($550)
If you will be selecting Double Occupancy - please list your roommate. Listing your roommate does not register them. They must register separately.
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