2024 Revitalze

Please note that if you are paying by check your registration IS NOT finalized until your payment is received. Once your payment is received you will receive a confirmation email.

Full payment must be received by September 10th.

Contact Name

Church Name

Church Address

Phone Number

Association

Do you have any dietary restrictions?

PHOTO & VIDEO CONSENT / RELEASE

During this event, KBC will/may be recording (audio and video) and photographing. Most likely, you will be filmed, recorded or photographed as part of the audience or individually. By your attendance, you are granting your permission to be recorded or photographed for commercial purposes and agree to the following: being recorded, filmed or photographed by any means; commercial or any other use of your likeness, voice and words without compensation; specifically waving all rights of privacy during the filming, recording or photographing and release Kentucky Baptist Convention from liability for loss, damage, or compensation from the commercial or other use of your likeness, image, voice or word; compliance with all rules and regulations of KBC for this event. PLEASE GIVE YOUR CONSENT BY CHECKING THE BOX.

Conference Fee

$10 Early Bird Pricing

(Price Will Increase to $15 each After October 10th)

Number of people

Total

$0.00

Coupon Code

Billing Information

Name

Payment Method

Credit Card
Check

Credit Card

Visa
Mastercard
American Express
Discover

Billing Address

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