conference registration form

10th Annual “Gertrude Gaston”

Widows Prayer Gathering and Conference

Registration Deadline May 10, 2010

Name____________________________________________________________

Address__________________________________________________________

City______________________________State________Zip_________________

Phone_____________________Email__________________________________

Church___________________________________________________________

City______________________________State_______Zip__________________

Street Address_____________________________________________________

Church Phone_______________  Pastor’s Name__________________________

____I am a Widow                                ____I am not a Widow