EmailMe Form - IMPACTT Women's Ministry

Title (ie. Pastor, Rev., First Lady, Sis.)
Name
First Last
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Cell Phone
### - ### - ####
Home Phone
### - ### - ####
Email
Church Home
ACCOMMODATIONS
Double Room ($475) - Regular Registration
Double Room ($455) - Seniors: 55+
Double Room ($465) - Cancer Fighters/Survivors
Single Room ($697)
Name of Roommate (Please remember that each woman must register separately --There can only be one person in single rooms and two people in double rooms)
Special Needs
PAYMENT - Once you click submit, please go back to the womenofIMPACTT.com site and click on the "Make Payment with Secure Give" button so that you can make your payment. **IMPORTANT: Please be sure to click "Make a Payment" instead of "Make a Donation". If you have any questions, feel free to contact us at 704-567-2900.
All payments are non-refundable. Payments are non-transferrable if less than $150.00 paid.
***REGISTRATION NOT COMPLETE UNTIL DEPOSIT PAYMENT IS MADE***