Gulf Coast Men’s Empowerment Conference Individual Registration Form July 31 – August 2, 2014 Liberty Missionary Baptist Church 1759 Dr. Martin Luther King Jr. Avenue Mobile, Alabama 36617 Phone (251) 479-4460 Rev. Dr. Clyde Maye, Jr. Pastor Conference information: www.libertymbchurch.org Full Name: _______________________________ (First name for badge)_______________________ Church /Organization: ________________________________________________________________ Mailing Address:_____________________________________________________________________ City: __________________________________________ State/Province: ______________________ Zip/Postal Code: ______________________ Cellphone: (______)____________________________ Email: ____________________________________________________________________________ CONFERENCE FEES 1. Registration Fees Includes all events and Networking, 3 meals over the course of the Conference. POSTMARKED & PAID PLEASE CHECK APPROPRIATE REGISTRATION FEE: BEFORE/ON JUNE 31 AFTER JUNE 31 Individual Rates Men 18 & Over 18 & Under  $12  $5  $15  $7 Cancellations/Changes and Refunds: There will be NO REFUNDS offered for missed sessions, late arrivals, and early departures. If rescheduling is necessary due to inclement weather all funds will be applied to rescheduled date. PAYMENT METHOD: Check or Money Order payable to: Liberty Mission Baptist Church. There will be a $25.00 fee charged on checks returned by the bank due to insufficient funds. No Check will be received for payment after July 13, 2014. After July 13, 2014 all payment will only be received in CASH ONLY. Registration confirmation/receipt and further information will be mailed. Please check appropriate box:  Check Mail form and payment to:  Money Order Liberty Missionary Baptist Church 1759 Dr. Martin Luther King Jr. Avenue Mobile, Alabama 36617 (251) 479-4460 Attn. Gulf Coast Men’s Empowerment Conference For More Information Email: Cicone@ciconeprince.com Gulf Coast Men’s Empowerment Conference Group Registration Form July 31 – August 2, 2014 Liberty Missionary Baptist Church 1759 Dr. Martin Luther King Jr. Avenue Mobile, Alabama 36617 Phone (251) 479-4460 Rev. Dr. Clyde Maye, Jr. Pastor Conference information: www.libertymbchurch.org Full Group POC Name: __________________________ (First name for badge)___________________ Church /Organization: ________________________________________________________________ Mailing Address:_____________________________________________________________________ City: __________________________________________ State/Province: ______________________ Zip/Postal Code: ______________________ Cellphone: (______)____________________________ Email: ____________________________________________________________________________ CONFERENCE FEES 1. Registration Fees Includes all events and Networking, 3 meals over the course of the Conference. POSTMARKED & PAID PLEASE CHECK APPROPRIATE REGISTRATION FEE: BEFORE/ON JUNE 31 Group Rates Groups of 10 or More  $10 AFTER JUNE 31  $12 Add Names for Group Members on Attached Sheet. Cancellations/Changes and Refunds: There will be NO REFUNDS offered for missed sessions, late arrivals, and early departures. If rescheduling is necessary due to inclement weather all funds will be applied to rescheduled date. PAYMENT METHOD: Check or Money Order payable to: Liberty Mission Baptist Church. There will be a $25.00 fee charged on checks returned by the bank due to insufficient funds. No Check will be received for payment after July 13, 2014. After July 13, 2014 all payment will only be received in CASH ONLY. Registration confirmation/receipt and further information will be mailed. Please check appropriate box:  Check Mail form and payment to:  Money Order Liberty Missionary Baptist Church 1759 Dr. Martin Luther King Jr. Avenue Mobile, Alabama 36617 (251) 479-4460 Attn. Gulf Coast Men’s Empowerment Conference For More Information Email: Cicone@ciconeprince.com Gulf Coast Men’s Empowerment Conference Group Registration Form July 31 – August 2, 2014 Liberty Missionary Baptist Church 1759 Dr. Martin Luther King Jr. Avenue Mobile, Alabama 36617 Phone (251) 479-4460 Rev. Dr. Clyde Maye, Jr. Pastor 1. ______________________________________________ 2. ______________________________________________ 3. ______________________________________________ 4. ______________________________________________ 5. ______________________________________________ 6. ______________________________________________ 7. ______________________________________________ 8. ______________________________________________ 9. ______________________________________________ 10. ____________________________________________ 11. ____________________________________________ 12. ____________________________________________ 13. ____________________________________________ 14. ____________________________________________ 15. ____________________________________________ Make copies and use additional sheets if necessary. For More Information Email: Cicone@ciconeprince.com