Registration Form

Date: ____________________________

Name: ____________________________

Position: __________________________

Instit./Church: _______________________

Address: __________________________

City: ______________________________

State/Pr.: ______ Zip/Po.Code _________

Office Phone: (_____)_______________

Home Phone: (_____)_______________

EMail: _____________________________

Registering on behalf of: ____________________________

Registration fees include meals. Please indicate if you have any special food requirements:
_______________________________________________________________________

Please fill in the appropriate amounts:

$__________ Annual Dues ($50 Individual Members; $25 Associate Members - US Funds)

$__________ Conference Registration: $150 US

$__________ Spouse's Conference Reg.: $50 US

Spouse's Name: _____________

$__________ TOTAL ENCLOSED

Please make checks payable to: Evangelical Homiletics Society. Mail this form along with your check to:

Dr. Shawn Radford, c/o Taylor Seminary - 11525 23 Ave, Edmonton, AB T6J4T3 Canada