Registration Type Choose your Registration Type Individual Registration Faith Partner Registration
Purchase your individual conference admission
Use this form to purchase a new group package (starting at $375 for 25 attendees).
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Select Payment Package Select Payment Package Individual Package Group Package: 25 attendees ($375) Group package: 26 attendees ($390) Group package: 27 attendees ($405) Group package: 28 attendees ($420) Group package: 29 attendees ($435) Group Package: 30 attendees ($450) Group package: 31 attendees ($465) Group package: 32 attendees ($480) Group package: 33 attendees ($495) Group package: 34 attendees ($510) Group package: 35 attendees ($525) Group Package: 36 attendees ($540) Group package: 37 attendees ($555) Group package: 38 attendees ($570) Group package: 39 attendees ($585) Group Package: 40 attendees ($600) Group package: 41 attendees ($615) Group package: 42 attendees ($630) Group package: 43 attendees ($645) Group package: 44 attendees ($660) Group package: 45 attendees ($675) Group package: 46 attendees ($690) Group package: 47 attendees ($705) Group package: 48 attendees ($720) Group package: 49 attendees ($735) Group Package: 50 attendees ($750) Group package: 51 attendees ($765) Group package: 52 attendees ($780) Group package: 53 attendees ($795) Group package: 54 attendees ($810) Group package: 55 attendees ($825) Group package: 56 attendees ($840) Group package: 57 attendees ($855) Group package: 58 attendees ($870) Group package: 59 attendees ($885) Group Package: 60 attendees ($900) Group package: 61 attendees ($915) Group package: 62 attendees ($930) Group package: 63 attendees ($945) Group package: 64 attendees ($960) Group package: 65 attendees ($975) Group package: 66 attendees ($990) Group package: 67 attendees ($1005) Group package: 68 attendees ($1020) Group package: 69 attendees ($1035) Group package: 70 attendees ($1050) Group package: 71 attendees ($1065) Group package: 72 attendees ($1080) Group package: 73 attendees ($1095) Group package: 74 attendees ($1110) Group package: 75 attendees ($1125) Group package: 76 attendees ($1140) Group package: 77 attendees ($1155) Group package: 78 attendees ($1170) Group package: 79 attendees ($1185) Group package: 80 attendees ($1200) Group package: 81 attendees ($1215) Group package: 82 attendees ($1230) Group package: 83 attendees ($1245) Group package: 84 attendees ($1260) Group package: 85 attendees ($1275) Group package: 86 attendees ($1290) Group package: 87 attendees ($1305) Group package: 88 attendees ($1320) Group package: 89 attendees ($1335) Group Package: 90 attendees ($1350) Group package: 91 attendees ($1365) Group package: 92 attendees ($1380) Group package: 93 attendees ($1395) Group package: 94 attendees ($1410) Group package: 95 attendees ($1425) Group package: 96 attendees ($1440) Group package: 97 attendees ($1455) Group package: 98 attendees ($1470) Group package: 99 attendees ($1485) Group Package: 100 attendees ($1,500) 0.0
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Select Payment Method Select Payment Method PayPal 3D Secure (PayPal) Check (Check)
Please note: All credit card payments are processed through PayPal Checkout. You do not need a PayPal account for this transaction. When using a Credit/Debit Card for payment, the receipt will still be sent from PayPal Checkout.
Check payment instructions will be included in the group pre-registration confirmation email
Name Prefix
First Name
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Name of Church/Organization/Company
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Country Please select United States Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo (Congo-Brazzaville) Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czechia (Czech Republic) Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini (fmr. "Swaziland") Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar (formerly Burma) Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea North Macedonia Norway Oman Pakistan Palau Palestine State Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Yemen Zambia Zimbabwe
I am registering for the Conference as (Select One Organizational Role Below.) Data used for reporting purposes only. (Select One Organizational Role Below) Data used for reporting purposes only. Congregation Member, Healthy Ministry, and Faith-based Organization Ministerial Leaders (Bishops, Pastors, Executive Ministers) Public Health, Academic and Research Partners Community Health and Social Workers Healthcare Professionals (Clinical, Providers, Nurses, Allied Healthcare Professionals) Private Sector Professionals
Congregation Member, Healthy Ministry, and Faith-based Organization Please Select One Health Ministry Coordinator Church Member Church Administrator Missionary Faith-Based Organization Other Other
Ministerial Leaders (Bishops, Pastors, Executive Ministers) Please Select One Senior Pastor/Executive Ministry Leadership Licensed/Ordained Minister Other Other
Public Health, Academic and Research Partners Please Select One Public Health Professional Educator/Researcher/Academic Professional Student Other Other
Community Health and Social Workers Please Select One Community Health Worker Social Worker Other Other
Healthcare Professionals (Clinical, Providers, Nurses, Allied Healthcare Professionals) Please Select One Medical Doctor Nurse Health Department Representative Healthcare Provider Other Other
Private Sector Professionals Please Select One Corporate Sponsor Exhibitor Business Executive Nonprofit/CBO Leader Pharmaceutical Executive Marketing/PR Professional Elected/Public Official Governmental Employee Volunteer Other Other
Tell us how you found out about the Healthy Churches 2030 Conference this year? Please select Conference Speaker Conference Sponsor Direct Outreach Email Campaign Google/Digital Advertisement Past Conference Attendee Print Advertisement Radio/TV Promotion Referral/Word-Of-Mouth Social Media Advertisement Social Media Influencer Website Other Other
