Genesis Men’s Conference Registration Page Genesis Men’s Conference Registration Page "*" indicates required fields Please fill out the information below to registerName* First Last Phone*Email* Address* Street Address City State / Province / Region ZIP / Postal Code Parish*Mother of GodSt. ThomasHoly CrossMar AddaiSacred HeartSt. JosephSt. GeorgeHoly MartyrsOur Lady of Perpetual HelpSt. PaulMart MariamOtherNoneAgeHow did you hear about the conference?*Genesis 4:9 Mens GroupChurch AnnouncementFamily/FriendSocial MediaOtherToday's Date Do you have or are you a high school student who will be joining the conference Yes No Number of Tickets (16 and older) Quantity* Price: $25.00 Quantity Number of regular tickets Quantity Price: $25.00 Quantity Number of High School tickets Quantity NOTE: Please bring the high school ID of the person registered so that we are able to verify them being in high school Price: $10.00 Quantity Names of AttendeesPlease add names of attendees including yourself if you buy 2 or more tickets.Subtotal $0.00 Please check below if you would like to help ECRC in covering the 3.5% credit card fees YES CC Processing Fees Price: $0.00 Total Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name Δ
