Beautifully Broken Group Registration Form
Complete this form to register as a group for the Beautifully Broken Ladies Conference. To register as an individual, please go back to citcdallas.com and click the link marked Beautifully Broken Individual Registration Form
Email address
Group Name
Please give your church, group or organization name
Your answer
Your First and Last Name
Please give your name as it appears on your ID/Driver's License
Your answer
Your Date of Birth
MM
/
DD
/
YYYY
Your Gender
Your Phone Number
Your answer
Your Mailing Address
Street Number and Name, City, State and Zip Code
Your answer
Contact Us
Phone: 972-412-8266 ext. 225 | ladiesministry@citcdallas.org
Number in your group
Street Number and Name, City, State and Zip Code
Payment Information
Registration Cost = $50.00 per person.Once this form is submitted, payment can be made by following the link on the submission page and choosing "Beautifully Broken" from the "Category & Funds" Menu.Complete all the giving information requested and then submit your payment. Download instructions for payment here https://drive.google.com/open?id=0B23WNUVM6akkQ25zNjVMMXYwQzA
Number of Children
If you will need childcare for children up to age 7, please list the total number of children here.
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
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