Register for the 26th Annual Southern Interstate Ministries Conference

CONVENTION & HOTEL REGISTRATION
Southern Interstate Ministries of the Church of God
Crown Plaza Baton Rouge 

Friday, August 31 through Sunday, September 2, 2012 

SIMC REGISTRATION

Registration is a THREE (3) STEP Process.

Step 1: Payment
Step 2: Complete & Submit Registration Form
Step 3: Reserve Your Hotel Room

STEP 1: Payment
Click the appropriate button below and pay for your registration.

Registration
$45.00 (ages 13 and Up)

$25.00 (ages 12 and Under)
STEP 2: Complete the Registration Form
Complete the following form and click the Submit button OR download a copy of the registration packet, complete the attached registration form and mail it to...

SIMC Registration
Attn: Ms. Lula Holmes
803 Runners Ridge
Pflugerville, TX 78660

STEP 3: Reserve Your Room
Click here to reserve your room reservations.

Hotel - $84.00 (+ taxes at 13%)

You MUST contact the hotel (Reservation Code: MIN),
NOT the Registrar to reserve a room.

AUGUST 25 is the FINAL DAY to reserve a room for the $84.00 (+ taxes @ 13%) conference rate.

Please contact us for more information if you have questions.
Name of Congregation: *
Pastor's Name: *
Contact Person: *
Phone Number (+ Area Code:) *
Email: *
Registrant 1 *
Registrant 2:
Registrant 3:
Registrant 4:
Registration:
$35.00 (Ages 13 & Up): *  (Type the # of registrations needed. If none, type "0".)
$25.00 (Ages 12 & Under): *  (Type the # of registrations needed. If none, type "0".)
Room Type:
King: *

 (Type the # of King bed size rooms needed. If none, type "0".)
Double: *  (Type the # of Double bed size rooms needed. If none, type "0".)
Total Amount of Registration: *
(Add the above item and type the total amount)
Arrival Date & Time: *
Departure Date & Time: *
Comments:

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