Registration Form

Mission Revive America! The Awakening Registration form Please Print this page out and fill out information! Roger Webb Ministries reserves the rights to screen all applicants for this Mission Revive America trip May 23-28 All lines must be filled out! Name     ____________________________ Address ____________________________               ____________________________               ____________________________ Phone    ____________________________ Email     ____________________________ Number of Rooms ____________________ How many will be in your group  ______ Is this a family ____ or group ____ Please tell us about yourself on the back of this registration form. Our office will be contacting you and speaking with you directly! Please mail in registration form and a NON-REFUNDABLE deposit of $100 per room by March 1, 2010 Make checks out checks to: Roger Webb P.O.Box 568961 Orlando, Florida 32856 webbrevivals@gmail.com A complete registration pack will be sent shortly after receipt of deposit. ______________