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Extravaganza 2012 Registration
Thank you for registering for the Extravaganza!  We are very glad that you'll be joining us in New Orleans.  There are 3 steps to our registration process:

1.  Registration:  Please fill out the registration form below.  At the bottom of the form, you will have the opportunity to select your payment method: "Invoice my church" or "Pay by credit card."  After you click on the "Register Now" button, you will be taken automatically to an online payment section. 

2.  Payment:  If you had selected "Pay by credit card," select your "items" to go in your shopping cart and proceed as with any online purchase.  If you selected "Invoice my church" you can just close the browser when you get to the payment page.  Your registration is complete at that point.

Last Name

Fist Name

Position Title

Preferred Mailing Address

City

State

Zip Code

Congregation/Organization

Church/Organization Address

Congregation’s City

Congregation’s State

Congregation Zip Code

Work Phone

Home Phone

Cell Phone

Fax Number

E Mail Address

ELCA Region

Synod:

Years in ministry:

Years in current position:

I would like to register for the following Intensive Care Course:

Extravaganza: I am registering for (please check all that apply):

     
     
   

Network Membership: I am paying now for):

   
   
   

I am a member of LACE:

The total from the above items:

$

Event Shirt Size (if ordered a shirt):

Payment Options:

In an effort to connect you with people working in similar areas, please check all that apply:

     
     
     
   
   

For demographic purposes, please tell us your race/ethnicity

     
   
   

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