Click on image below

You may print and complete the form above and
send it with check or money order to
Kingdom Ministries Church
P.O. Box 1663
Dubuque, IA 52004-1663.

   

Online Registration

Cecilia Lott Ministries & Kingdom Ministries Church Presents
Gods Sons & Daughters Headed for Destiny Conference 2011
October 14th and 15th 2011
Kingdom Ministries Church
2501 Jackson Street
Dubuque, Iowa 52001

For credit card payment for luncheon fee call Executive/Administrative office at (563)-584-9334 or (563)-213-4657

Registration is required to all Conference Attendees
The Conference Workshop & Services are Absolutely Free &
the Catered Luncheon will be $20.00 in advance and $25.00 at the door
Complete the form below and click Register Now.
An Email address is Required to Complete Online Registration Successfully!
If you do not have an Email address you may use Noemail@yahoo.com to complete the form!

All fields marked with asterisk (*) are required.

Name*
Address*
City*
State* Zip*
Church*
Phone*
E-mail Address*
What days will you be attending? (Choose 1 or both)*
Friday, 10/14/11
Saturday, 10/15/11
Both
Do you want to sign up for the catered luncheon to be held at 11:30 am on Saturday, October 15th?
($20.00 per person in advance, $25.00 per person AT THE DOOR.)*
Yes   No
If attending the luncheon, please choose one of the main entrees listed below.*
Fried Chicken
Turkey Leg
Will you be paying in advance or at the door?*
Pay in advance: please call the office at (563)-584-9334 or
(563)-213-4657 to make a credit card payment / or mail check or money order to the address at the bottom
Pay at the door : cash accepted at the door only
Comments

You may complete and submit this form and send your check or money order (no cash) made payable to: Kingdom Ministries Church
Kingdom Ministries Church
P.O. Box 1663
Dubuque, IA 52004-1663

For any questions or to make your credit card payment call (563)-584-9334 or (563)-213-4657

Or you may print and complete this form and send with check or money order to the above address.

If you have any technical issues with this form, please call 563-582-2655