Where do you fit in?

IDIOM Registration Form

Date you plan to attend IDIOM: May 29-31, 2008 August 7-9, 2008

Your e-mail address is needed if you wish to receive registration confirmation by e-mail.


E-mail address:

The following information is needed so we can send you an information packet by mail. The packet will be mailed a few weeks before IDIOM.


            Name: 
         Address: 
            City:   State/Province: 

     Postal Code:          Country: 
           Phone:

Permanent address and phone information if different from above:

Date of Birth:

Marital Status: Single Married   Spouse name:

In case of emergency, whom do you want us to contact?
(Please provide name, relationship, address and phone information.)

Briefly describe your interest in LBT and explain why you want to attend IDIOM:

Please comment on any dietary restrictions or allergies that might affect where you stay:

Please provide your Pastor's name, Church name, address and phone information:

Number of adults and children attending IDIOM.
(Please list names and ages of children.)

If flying into Chicago, please list your flight information so pick up arrangments can be made:
(Airline/Flight Number, City of Departure, Date and arrival time, Date and departure time.)

Please add any comments or questions you may have about IDIOM:

By checking this box, I am confirming this OnLine Registration.

If you are satisfied with everything you entered, click the "Send" button below.

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