Millersburg Church of God
Seminar Registration Form
Registration Fee
for the two-day Seminar is $45 per person. For groups of 5 or more registering together, the Registration Fee is $35 per person.
List Name and Address for each person including yourself:
Registration for Pizza Lunch at seminar location:
Registration for Dinner in an Amish Home:
Child Care
Please check if you need child care during seminar times and
we will call you to make 
arrangements.
arrangements. Date of Registration
FIRST NAME:
LAST NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP:
EMAIL ADDRESS:
PHONE #:
Meal Reservations: On Saturday, you may register to have a pizza lunch at the seminar site or choose to go out for lunch. If you prefer to go out for lunch, please enter 0 after the $ sign for the Pizza Lunch. You may also register to have dinner at 6:30pm in an Amish home. If you are not interested in the Dinner in an Amish Home, please enter 0 after the $ sign for Dinner in an Amish Home.
Total Amount for Meal Reservations:
Please add the $ amount for Pizza Lunch and Dinner in Amish Home and put total in B box. Put 0 if not registering for either meal registration. Please list the total in the Registration & Reservation Recap at bottom of page.
Seminar Registration & Reservations Recap:
Payment Options:
Refunds for cancellations will be given only if Cancellation is received in writing no later than June 5, 2015.
Rev. Mark Virkler,PhD.
July 10-11, 2015
A
B
Total Amount for Registration Fees:
Please list the total number of reservations in A box and multiply amount times $45 each to get total of Registration Fee. If you have 5 or more registering together, use the second box and list the total number of registrations and multiply amount times $35 each to get total of Registration Fee. Please list total in the Registration & Reservation Recap at bottom of page.
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PLEASE NOTE: YOUR REGISTRATION IS NOT COMPLETE UNTIL YOU PRESS THE
SUBMIT REGISTRATION BUTTON
If paying by PayPal, submit your payment for Total Amount Due by clicking on PayPal button and then you will return to this page to Submit Registration to us.
If paying by Check/Money Order, submit your payment
for Total Amount Due payable to The Food Pantry
and mail to:
Janet Yoder
7918 Township Road 103
Millersburg, Ohio 44654
Please click the Submit Registration button below after
making out your check/money order and writing down
the address.
