Church of God 72nd International General Assembly
                                                                                               DELEGATE REGISTRATION
                                                                                                          August 4-9, 2008 – San Antonio, TX
NAME               Please type or print all information legibly.                             If Minister, Please List File #            ___ ___ ___ ___ ___                                     RANK                                   GA Minutes S2 Article VI                                              OFFICE USE ONLY
                                                                                                                                                                                           A       Ordained Bishop
                                                                                                                                                                                                                                  1. International General Assembly                                                                Entered
Last                                                                            First                                                                 M.I.                                         Ordained Minister
                                                                                                                                                                                           C       Exhorter                                    Members                                                      Date Rec.
                                                                                                                                                                                           D       Minister of CE                                                                                           Amt. Paid
Date of Birth                                                                               Hearing Impaired                         Physically Challenged                                 E       Minister of Music         The International General Assembly is composed of all
                                                                                                                                                                                           F       Layperson Sign           members and ministers of the Church of God 16 years of                          CK #
                                                                                                                                                                                           G       Widow of Minister        age and above. Members and ministers of the Church of
Address (Street or P.O. Box)                                                                                                                                                               H       Non-Member
                                                                                                                                                                                                                                                                                                            CC Batch
                                                                                                                                                                                                                             God present and registered at the International General
                                                                                                                                                                                                STATUS                          Assembly shall comprise its voting constituency.
City                                                                               State                                           Zip
                                                                                                                                                                                           A       Full-time
                                                                                                                                                                                           B       Part-time                         Lay Delegate Affirmation
                                                                                                                                                                                           C       Retired                    Must be completed to register as a LAYPERSON.                                     Please Note
                                                                                                                                                                                                                           Local church where you are a member:
SPOUSE NAME                                  (if attending and registering)                  If Minister, Please List File #            ___ ___ ___ ___ ___                                     RANK                                                                                                         If paying by Check or
                                                                                                                                                                                                                                                                                                             Money Order, do not Fax.
                                                                                                                                                                                           B       Ordained Minister       Church Name __________________________
                                                                                                                                                                                           C       Exhorter                                                                                                  Mail Registration Form to:
First                                                                                      M.I.                                                                                            D       Minister of CE          City & State ___________________________
                                                                                                                                                                                           E       Minister of Music                                                                                         GA Registration
                                                                                                                                                                                           F       Layperson Sign          Regional Office Name _____________________
Date of Birth                                                                               Hearing Impaired                         Physically Challenged
                                                                                                                                                                                           G       Widow of Minister
                                                                                                                                                                                                                                                                                                             PO Box 2430
                                                                                                                                                                                                                               I affirm that I am a member of the above church.
                                                                                                                                                                                           H       Non-Member                                                                                                Cleveland TN 37320
                                                                                                                                                                                                STATUS                                                                                                       Make Check or Money Order
CONTACT INFORMATION                                                                                  Day Phone                                                                             A       Full-time                                       Lay Delegate Signature                                    (US Funds ONLY) Payable to:
                                                                                                                                                                                           B       Part-time
Email Address                                                                                                   Fax                                                                        C       Retired                                                                                                   GA Registration
                                                                                                                                                                                                                                               Spouse Lay Delegate Signature

YOUTH                 (ages 15 & under)                                       Print names and ages of children AGES 15 & UNDER ONLY attending with you. These registrations are complimentary.

 Name                                                                                                            Age (15 & Under)                                              Name                                                                                                            Age (15 & Under)

 Name                                                                                                            Age (15 & Under)                                              Name                                                                                                            Age (15 & Under)
         P l e a s e N o t e : Persons aged 16 or above listed in this section of the form will NOT be registered and may cause a delay in the processing of the entire registration. Because young adults ages 16-19 who register have voting privileges,
         they must complete a separate form from their parents AND sign the Lay Delegate Affirmation. The registration fee for 16-19 year olds is $10 each. Teen Talent requires separate registration through the Youth & Christian Education Dept.

                                        early f ee d ue     regu lar f ee a p pli e s
FEE                                   by 5/30/08 after 5/30/08
                                                                                           there is no fee for senior registration                               PAYMENT                                                                     Registration cannot be processed without payment in full.

                                                                                                                                                                                                                                                      Please Select Amount Paid By Check, Money Order or Credit Card
        Individual (age 20-65)                  $40                    $45                  $0    Senior or Senior Couple (65 and over)                                Check                #
                                                                                        To qualify for FREE Senior registration, be sure to list your
                                                                                                                                                                                                                                                             $10              $40               $45              $65              $75
Married Couple (under 65)                       $65                    $75              date of birth (including year) on form above. Please Note:                     Credit Card          #
                                                                                        Only one spouse (husband or wife) is required to be 65 or
  Young Adult (age 16-19)                                                               over to qualify a couple for free senior registration.                   Card Expiration Date                                                     Signature
                                                $10                    $10
       -Manual not included-
                                         P L E A S E                     C H E C K                 O N E             B O X             O N L Y                   Visa, MasterCard, American Express & Discover                                        If paying by credit card you may FAX form to: 423-478-7260

Q U E S T I O N S ? Contact our Registration Office by email or phone 1-800-323-RCOG (7264) Monday-Friday from 9:00am to 5:00pm Eastern.
       Go to to apply for HOUSING and/or complete your registration ONLINE (please do not duplicate your registration by registering online and sending this form).
        The EARLY FEE Cutoff Date is 5/30/08. The DEADLINE for pre-registration is 6/30/08. Registrations submitted after the deadline will NOT be processed.
           Delegates should receive confirmation within three weeks of registering. Credentials will be mailed to all pre-registered delegates at least 10 days prior to the General Assembly. Registrations received after the pre-registration deadline will be returned, and registration will be required onsite in San Antonio.

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