PSMC Assembly Registration

Please take the time to fill out the information below. For payment, checks can be made out to Pacific Southwest Mennonite Conference and either mailed to the PSMC office or submitted during Assembly. Cash is also accepted. REGISTRATION IS $30 PER PERSON.

Please note that payments made via PayPal are nonrefundable.

* Required

Please fill-in questionnaire boxes in red.

What is your name? *

What is the name of the church you attend? *

Are you a delegate? *

What is your church's full address? *

What is your phone number? *

What is your email address? *

What is the number of people you are registering for (including yourself)? * Registration is $30 per/person

How do you anticipate paying? * Cash, Check or with credit card through Pay Pal?

Do you anticipate needing child care? And if so, how many and what age/s? *