Chad Bird @ Life Center of Brandon Registration Form

Chad Bird Registration Form
Do to limited seating, serious registrations only.
There will be NO seating available for children under 12yrs of age.
However, childcare will be provided during the services for ages 11yrs and under at $5 per child.

* Indicates required field

Which service(s) will you be attending? *

10:30 am 6:30 pm Both

Name *

First

Last

# of additional guests *

Email *

Phone Number *

Guest 1 Name *

First

Last

Guest 1 Service Attending *

10:30 am 6:30 pm Both

Guest 2 Name *

First

Last

Guest 2 Service Attending *

10:30 am 6:30 pm Both

Submit