RTS Discovery Registration Form

THE DISCOVERY SEMINAR REGISTRATION FORM

FIRST NAME _______________________________LAST NAME ______________________________________
NAME THAT YOU PREFER TO BE CALLED _________________________________________________________
STREET ADDRESS: __________________________________________________________________________
CITY: ________________________________________ STATE: ________ ZIP: _________________________
E-MAIL ADDRESS: __________________________________________ALTN E-MAIL: _____________________
HOME PHONE:___________________________________WORK PHONE:______________________ EXT: _____
BEST TIME TO CALL: ________________________________________________________________________
OCCUPATION: ___________________________________EMPLOYER: _________________________________
BIRTHDATE: ____________________________________ AGE: ______________________________________
NUMBER OF CHILDREN: _________ AGES OF CHILDREN: ___________________________________________
WHO REFERRED YOU? ________________________________________________________________________
YOUR CHURCH: __________________PASTOR'S NAME: _______________PASTOR'S PHONE: _____________
THREE AREAS IN MY LIFE THAT I WOULD LIKE MORE CLARITY ARE…
1 _________________________________________________________________________________________
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2 _________________________________________________________________________________________
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3 _________________________________________________________________________________________
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MY PURPOSE FOR ATTENDING THE DISCOVERY SEMINAR IS…
__________________________________________________________________________________________
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I AM COMMITTED TO PARTICIPATING IN THE SEMINAR AS SCHEDULED:
__________________________________________________________________________________________
SIGNATURE DATE

PLEASE INDICATE HOW YOU WOULD LIKE TO RECEIVE YOUR SEMINAR INFORMATION PACKET?
VIA: E-MAIL _______ REGULAR MAIL ________ FAX (FAX #_____________________)

Please Make Checks For $200 Registration Fee* Payable to (and Send to):
RTS (Reconciliation Training Service) P O Box 533 Amherst NH 03031
*PLEASE NOTE: Registration Fee of $200 is Non-Refundable