NBHE Family Summer Conference 2010
Built to Last
Embassy Suites Hotel Baton Rouge, LA
(225) 924-6566
July 1st – 3rd 2010
Onsite Registration Form
13434 Plank Road – PMB – 110 -Baker, Louisiana 70714
Please print
Parent(s) _____________________________________________
Youth (11-17) – Presenting: Young People in Government
Child: (4-10) – Presenting: Character First Program
Grandparent (registration required - (free admittance if accompanying a paying family)
_________________________________________________
Address: ___________________________________________________________
Telephone Numbers:
_______________________________________________________
Email Address:
____________________________________________________
Please check appropriate fees:
Married Couple _____ $55.00
Individual ______ 50.00
Youth _____ 20.00
Child ______ 15.00
Grandparents (see above)
Pastor 15.00
Payment Method: Checks payable to NBHE Check #_______Amt._______
Card #__________________
Exp.________
Cash______________
Please sign: I hereby hold NBHE, its staff, Embassy Suites Hotel, workers, etc. blameless of any liabilities during Conference 2010
Signature:__________________ Date_____________________