REGISTRATION FORM

ADDRESS: ______________________________ CITY _______________ ST__ Zip ______

PHONE:(H) __________ (W) __________ (FAX) __________ (CELL/PAGER) ___________

EMAIL: ______________________________ WEBPAGE _____________________________

OCCUPATION: ____________________ EMPLOYER: _______________________________

*Note: Please indicate your t-shirt size: ____

CHECK ALL THAT APPLY:

(Prices will increase after April 1st deadline!)

REGISTRATION:

Check All That Apply: (Indicate quantity#)

1. ___ $99 VIP ALL-ACCESS PASS (Includes: Film Fest Pass & Workshops)

2. ___ $75 (3 Workshops; 3 Films; Author's Breakfast or Award's Banquet; T-shirt and Cap)

3. ___ $35 VIP Prayer Breakfast & Movie

4. Other: _______________________________________

*VIP Pass includes: ALL EVENTS!

*Workshops are ($25 & Up)

April 1: Late Registration 20% Price increase

MAKE MONEY ORDER or CASHIER'S CHECKS PAYABLE TO:
MEMPHIS BWC
(We no longer accept personal or business checks)

Mailing Address:

Attn: Lawrence Wayne, MBWC
5100 Poplar Ave, Ste. 726 -Plaza Level* Memphis, TN 38137
901-680-2018 off

(No Refunds! Transferable. We need your name, phone and email address.)

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