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BC & YUKON DISTRICT CONFERENCE
April 27-29, 2015 | Broadway Pentecostal Church (2700 E. Broadway, Vancouver)
REGISTRATION FORM
Name: ______________________________________________ Spouse (if attending): ______________________________________
Address: _________________________________________________________________________________________________________
City
Province
Postal Code
Church/Ministry Name: ___________________________________________________________________________________________
Please check  primary registrant credential status in first column and spouse in the second:
VOTING:
Primary Spouse (if attending)








NON-VOTING:
Primary Spouse (if attending)




Ordained
Licensed Minister
Ministry Related
Recognition of Ministry




Primary Spouse (if attending)
Church Related Spousal
Ministerial License for Women
Deaconess
Lay Delegate (Note: an official written
confirmation from your Pastor or Church Board/
Pastors Council is required)








Ordained Provisional
Licensed Provisional
Recognition of Min. Provisional
Visitor
BOX "A" [CHECK ONE]
 INDIVIDUAL $93
 COUPLE
$138
 INDIVIDUAL Senior (65+) $68
 COUPLE Senior (65+)
$88
($108 at Conference)
($153 at Conference)
($83 at Conference)
($103 at Conference)
REGISTRATION FEES: We encourage you to Pre-Register as registration fees will be $15 more at the door.
TOTAL
BOX “A”
$ ________
PLEASE NOTE: Lunches are guaranteed to Pre-Registrants and may be provided to Post-Registrants as quantities permit.
Also, the first 300 pre-registrants/couples will receive either Hugh Halter’s book, “AND” or Mark Batterson’s book, “All In”.
SUBSIDY ASSISTANCE: Should you require subsidy assistance, visit www.bc.paoc.org/multiply to complete our online
application or contact our office for more information. The deadline to apply is April 14, 2015.
BOX "B" [CHECK APPLICABLE]
PLEASE NOTE that pre-registration is required to attend, as seating is limited for catered events listed below. Also, note that we are
unable to accommodate any food restrictions or allergies.
 Missions Dinner Banquet: Mon, April 27, 5:00pm
$12 per adult
I require_____ reservations = $ ____
$ 8 per child (4yrs to 12yrs)
I require_____ reservations = $ ____
 Legacy Builders (50+) Luncheon: Tues, April 28, 12:00pm cost included in registration fee I require_____ reservations
CHILDREN’S CONFERENCE:
AGES: 0 MONTHS-3 YEARS:
 $15 per child for all General Sessions and afternoons on Tuesday & Wednesday
childcare: $ ____
(drop-in at Conference is $5/child per session)
AGES: 4 YEARS-12 YEARS:
 $15 per child for all General Sessions only
(drop-in at Conference $5/child per session)
childcare for General Sessions: $ ____
Afternoon outings (Tuesday & Wednesday):
 $18 per child for Tuesday (bowling) and Wednesday (swimming)
childcare for afternoon outings: $ ____
OR  $12 per child Tuesday (bowling); OR  $6 per child Wednesday (swimming)
childcare for selected afternoon outing: $ _____
TOTAL
BOX “B”
$ ________
Children’s names & ages: ____________________________________________________________________________________________
Children’s allergies: __________________________________________________________________________________________________
TOTAL BOX "A" & "B" Enclosed $ ________
PAYMENT OPTIONS :
 Money Order
 Cheque
(Make payable to The Pentecostal Assemblies of Canada)
 Visa/Master Card Number #_________________________________________________ Expiry Date: Month: ______ / Year: ______
Name on Card: ________________________________________________ Signature: ________________________________________
(please print clearly)
Pre-register online at www.bc.paoc.org. Pre-registration to be received by the BCYD office no later than:
Online/Fax/Email: April 7, 2015 (payment with Visa/Mastercard only)
Mail: April 14, 2015 (post marked)
BC & Yukon District, PAOC | 20411 Douglas Crescent, Langley, BC V3A 4B6
email: [email protected] | Phone: 604-533-2232 | Fax: 604-533-5405