LOC Module - The Pastoral Leader • Alliance NW

Module Attendee 0

Module Attendee Information

First Name *

Last Name *

Email Address *

Mobile Number

Church *

Role *

Are you a module speaker or staff? *

Yes

Is this your first time attending a module? *

Yes

Please let us know which modules you have attended by filling out the month and year in the appropriate boxes below. Leave all unattended modules blank, including the one you are registering for.

Spirit Filled Leader Module Attended (Month/Year):

Missional Leader Module Attended (Month/Year):

Formed Leader Module Attended (Month/Year):

Pastoral Leader Module Attended (Month/Year):

Please select any dietary restrictions below that apply to you: *

None of the Following

Dairy Free

Vegetarian

Gluten Free

The ANW will cover lodging during the module (Feb 19 & 20). PLEASE NOTE: You may be rooming with another person during the module. *

Yes, I will need lodging

No, I do not need lodging and will arrange on my own

Tip: If you need lodging and require additional nights or would like to room on your own please email KaoXu (kaoxu@alliancenw.org)--Additional fees may be applicable.

I would like to room with:

Tip: FIRST and LAST name of the LOC Module attendee you would like to room with or N/A if you do not have a preference.

Check in date

Check out date

Ground Transportation

Yes, I will need ground transportation

No, I do not need ground transportation

Flight Information (Inbound)

Tip: Date & Time of arrival (PDX)

Flight Information (Outbound)

Tip: Date & Time of departure (PDX)