Diocese of Phoenix - CRM ANNUAL CONFERENCE

Contact Person or Group Leader Information *

Prefix/TitleFirst NameLast NameSuffix

E-Mail Address*

Phone Number*

Group Name (Not Required)

# Of Persons Registering*

NOTE: PLEASE READ AN FOLLOW THESE STEPS: 1.) Use the dropdown ABOVE to select number of people you are registering one or more people (up to 10 people). 2.) On the # field BELOW, enter 1, your name - if you are registering yourself and click "add row" IMPORTANT - by clicking "ADD ROW" enters the first participant's name in the system. 3.) If you are registering more than one, enter 2 on the # field, fill the info. (Emails are optional), and click "ADD ROW" again. 4.) Continue to add row until all registrant names are listed. 5.) Please end the process with "ADD ROW" to get the last name entered in the system. 6.) The numbers selected above should match the number of rows (names entered). 7.) Check the item selection below and change the quantity to match the number of persons registering above.

PAYMENT - Please check the item selection and match the numbers of people entered above with the "Quantity" dropdown below. Youth registration includes Lunch and Dinner. Adults lunch is available for purchase onsite. Adult BBQ Dinner Meal reservation available below.

REGISTRATION (Age 18 and over)$50.00

$50 Regular Registration (Adults and Young Adults Conference). No Lunch or Dinner.

Quantity

YOUTH REGISTRATION$35.00

ABLAZE Retreat - Saturday, May 24th, 9AM-9PM Grades 6 - 12 (Middle & High School age)

Quantity

Priest/Deacon/Religious/Seminarians$ Free

Priests, Deacons, Sisters, Brothers, Seminarians, and Nuns

Dinner Meal$10.00

Dinner meal includes a grilled hamburger or cheeseburger. Soda and Sides included.

Quantity

Donations$5.00

Please click the dropdown arrow to select your donation level and amount. Thank you for your generous donations!

Level

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Registration Payments are Non-Refundable.

Yes, I understand that Registration Payments are Non-Refundable. I confirm that the amount paid corresponds to the number of registrants. By registering to this event, you are granting the Diocese of Phoenix permission to use your likeness in photograph, video, other digital media.

For REGISTRATION QUESTIONS, please TEXT or CALL:

"H" Walsh at (406) 210-7867 or Laurie Walsh at (623) 670-1120

E-Mail: azmtbriwal@gmail.com

or E-Mail: Cathy Cato at: tewcatz@hotmail.com

REGISTRATION FORM