Would you like to register a group? *

Please tick yes if you are registering 2 or more people.

Yes

No (Please skip "Group Registration" and proceed to Individual Registration)

Group Leaders Name

First Name

Last Name

Name

First Name

Last Name

Do you attend a church?

If yes, please provide church details

Yes

No

$60 Registration

$15 Per Daytime Registration and $15 per Night Registration (Please indicate the night or day in the field below)

Please only fill out if you have ticked day and night Registration.

Tuesday Night

Wednesday

Wednesday Night

Thursday

Thursday Night

Payment Option *

*Refunds/Transfers: No refunds will be paid. Individual registrations can be transferred to another individual by placing the request in writing to History Makers Conference. *

Online (Please proceed to "online payment link" on following page, after submitting this registration form)

Direct Credit (Please find bank account details below)

Cash (To be handed in to 6 Kairn Rd, Strathdale either on a Sunday or during office hours)