WPBC Participant Registration Form

To register for this event, fill out the form below and return it to Woodland Park Baptist Church office with your registration fee.  Registration Fee is $100.00 non-refundable for Student and Adult. The Registration Form and payments are due no later than October 21, 2018.    

Date Submitted: ___________________
Gender: _______Male   _______Female
Name: ____________________________________________
Phone: (H) __________________(C):___________________
Address: ________________________________________City:______________________State:___________ZIP:________ E_Mail:____________________________________  
Parent/Legal Guardians’ Names: ___________________________

Grade:  (Circle one)   7th   8th    9th   10th   11th   12th  Adult

  Participant Signature or Parent/Guardian Signature: ____________________________________________________

Total cost: $100.00 (The cost includes the conference, hotel, transportation and gas.)

Date: Sunday, November 18, 2018 – Tuesday, November 20, 2018

Rapides Coliseum, Alexandria LA

Please send this form and your registration fee to:

Woodland Park Baptist Church

Student Ministry

1909 J.W. Davis Dr.

Hammond, La. 70403