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 B 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 Approval STATUS Assembly shall comprise its voting constituency. City State Zip A Full-time Country 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 GAReg@churchofgod.org or phone 1-800-323-RCOG (7264) Monday-Friday from 9:00am to 5:00pm Eastern. Go to www.churchofgod.org 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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