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Ambassador's Conference 2025 Sign Up Form
Dates: November 13-15, 2025
Location: New Heart Mission Church 
17 Herzog Place Hicksville, NY 11801
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Name (First and Last)  *
Gender *
Date of Birth (month, day, year)  *
What church are you currently serving and what is your role? How many years have you been serving?

 *
What state are you serving in?  *
Will you be coming from out of state? If yes, will transportation be needed? 
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What is your email address?   *
What is your phone number? Best form of contact  *
How many days will you be attending? We strongly encourage you to attend all three days. Please specify which days and sessions. *
Required
Comments/Questions (Please include if you have any food allergies) *
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