Please print the following form and mail it, along with your registration fee, to the Kentucky Council of Churches office at 2549 Richmond Road, Suite 302, Lexington, KY 40509.

NAME: _______________________________________________________________
ADDRESS: ____________________________________________________________
CITY: __________________________________STATE: _______ZIP: _____________
DAYTIME PHONE: (___)_____________ EVENING PHONE: (___)_____________
E-MAIL (if available) ____________________@_______________________________
DENOMINATION:______________________________________________________
CONFERENCE/SYNOD/DIOCESE/ASSOCIATION/JUDICATORY:
______________________________________________________________________

I will attend: _____ Thursday & Friday _____ Thursday only _____ Friday only

I will be unable to attend: _____

PLEASE COMPLETE THIS FORM AND RETURN IT TO THE OFFICES OF YOUR KCC AS SOON AS POSSIBLE FOR YOUR REGISTRATION TO THE ANNUAL ASSEMBLY. YOU ARE NOT REGISTERED UNTIL WE HAVE THIS FORM AND YOUR PAYMENT; IF YOU HAVE ONLY REGISTERED WITH YOUR DENOMINATIONAL OFFICE, YOU HAVE NOT REGISTERED WITH THE ENTIRE KCC. THANK YOU.

You may send the above information directly to jlh@kycouncilofchurches via email.