Midwest Ministers’ Retreat & Summit Registration Register for the Midwest Ministers' Retreat & SummitWe will not sell or otherwise disclose to third parties the information you provide via this registration form. Providing contact information will enable us to send you information about our next event or contact you should we have questions about your registration.Name* First Last Address* Street Address Address Line 2 City AAAEAKALAPARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY State ZIP Code Phone*Email Church*Number of Years in MinistryI PLAN ON BRINGING A FIRST TIME ATTENDER I PLAN ON BRINGING A FIRST TIME ATTENDER Registration optionsFull Registration - $30 ($20 for spouse)REGISTRATION FOR THE MIDWEST MINISTERS' RETREAT & SUMMIT* Full Registration Include Spouse Yes No Total $0.00 Payment Type* Pay with Credit Card Pay with PayPal Pay by Check Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name