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Regular Delegates Registration
Your Name:
Your Email:
How Many Delegates Are You Registering For?
1
2
3
4
5
6
7
8
9
10
Delegate #1:
First Name:
Middle Name:
Last Name:
Name You Want To Appear in your ID:
Address:
Contact Number:
Email Address:
Birthdate:
Gender:
Male
Female
Parish/Community/Elim Branch::
Civil Status:
Single
Married
Widow
Separated
Live-in
Employment Status:
Student
Employed
Self Employed
Homemaker
Unemployed
Delegate #2:
First Name:
Middle Name:
Last Name:
Name You Want To Appear in your ID:
Address:
Contact Number:
Email Address:
Birthdate:
Gender:
Male
Female
Parish/Community/Elim Branch:
Civil Status:
Single
Married
Widow
Separated
Live-in
Employment Status:
Student
Employed
Self Employed
Homemaker
Unemployed
Delegate #3:
First Name:
Middle Name:
Last Name:
Name You Want To Appear in your ID:
Address:
Contact Number:
Email Address:
Birthdate:
Gender:
Male
Female
Parish/Community/Elim Branch:
Civil Status:
Single
Married
Widow
Separated
Live-in
Employment Status:
Student
Employed
Self Employed
Homemaker
Unemployed
Delegate #4:
First Name:
Middle Name:
Last Name:
Name You Want To Appear in your ID:
Address:
Contact Number:
Email Address:
Birthdate:
Gender:
Male
Female
Parish/Community/Elim Branch:
Civil Status:
Single
Married
Widow
Separated
Live-in
Employment Status:
Student
Employed
Self Employed
Homemaker
Unemployed
Delegate #5:
First Name:
Middle Name:
Last Name:
Name You Want To Appear in your ID:
Address:
Contact Number:
Email Address:
Birthdate:
Gender:
Male
Female
Parish/Community/Elim Branch:
Civil Status:
Single
Married
Widow
Separated
Live-in
Employment Status:
Student
Employed
Self Employed
Homemaker
Unemployed
Delegate #6:
First Name:
Middle Name:
Last Name:
Name You Want To Appear in your ID:
Address:
Contact Number:
Email Address:
Birthdate:
Gender:
Male
Female
Parish/Community/Elim Branch::
Civil Status:
Single
Married
Widow
Separated
Live-in
Employment Status:
Student
Employed
Self Employed
Homemaker
Unemployed
Delegate #7:
First Name:
Middle Name:
Last Name:
Name You Want To Appear in your ID:
Address:
Contact Number:
Email Address:
Birthdate:
Gender:
Male
Female
Parish/Community/Elim Branch:
Civil Status:
Single
Married
Widow
Separated
Live-in
Employment Status:
Student
Employed
Self Employed
Homemaker
Unemployed
Delegate #8:
First Name:
Middle Name:
Last Name:
Name You Want To Appear in your ID:
Address:
Contact Number:
Email Address:
Birthdate:
Gender:
Male
Female
Parish/Community/Elim Branch:
Civil Status:
Single
Married
Widow
Separated
Live-in
Employment Status:
Student
Employed
Self Employed
Homemaker
Unemployed
Delegate #9:
First Name:
Middle Name:
Last Name:
Name You Want To Appear in your ID:
Address:
Contact Number:
Email Address:
Birthdate:
Gender:
Male
Female
Parish/Community/Elim Branch:
Civil Status:
Single
Married
Widow
Separated
Live-in
Employment Status:
Student
Employed
Self Employed
Homemaker
Unemployed
Delegate #10:
First Name:
Middle Name:
Last Name:
Name You Want To Appear in your ID:
Address:
Contact Number:
Email Address:
Birthdate:
Gender:
Male
Female
Parish/Community/Elim Branch:
Civil Status:
Single
Married
Widow
Separated
Live-in
Employment Status:
Student
Employed
Self Employed
Homemaker
Unemployed
