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Registration Form
Print out this form and send it along with your remittance to the address listed below. Remember, registration must be postmarked by May 20 to receive the early sign-up rate! 



Name: _______________________________________

Names of family members attending with you:


_____________________    ______________________


_____________________    ______________________


_____________________    ______________________



Mailing Address: _______________________________


City: ________________________  State: _________


Zip: ____________  Phone: ______________________


Email: _________________________________________


Home church: ___________________________________

Before April 25, conference fees are $20 per person, or $35 per family. After May 20, the fees are $25 per person or $45 per family.

Childcare is available for children up to age 4 at a cost of $10 per child for the conference.

A box lunch is available on Saturday at an additional cost of only $6. 

Registration fee:                  ___________

Childcare fee:    _____ @ $10/ea = ___________

Box lunch:        _____ @  $6/ea = ___________



TOTAL ENCLOSED:   ____________________________

Return this registration form with remittance to:

Heartlight, Inc.
Attn: Conference 2001
8332 Mesa Drive
Austin, TX 78759

  To the Praise of His Glory