RHPNA Event Registration Form

Name

This address will receive a confirmation email

Mobile Phone

Address

What ministry, organization or church are you connected to?

How did you hear about the Roundtable?

Newsletter Social Media Word of Mouth Website Other

If other, please write here.

Have you attended a Roundtable before?

Yes No

Would you like to be added to the WhatsApp group to ride share from the Airport to the Border?

Yes No

If you said yes, please put the phone number that you use on WhatsApp. Thank you

If you have someone you want to room with, please write their name here.

Registration Option - Please choose one option (note Early Bird finishes on July 30) Registration Cost covers registration, three nights in hotel (Sept. 30-Oct. 3), 3 meals on Thursday and Friday, and 1 meal on Saturday.

Give to the Scholarship Fund to support registration fee for attendees with lived forced displacement to attend.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

RHPNA Event Registration Form

Description

Please Fix the Following