Cornerstone Counseling

Please complete registration form for each attendee. Bring a group of 10 and the 11th person is free. Pastors please call for special rates.

Seminar Fees:
Early Bird: $45.00
After Sept. 1: $55.00

PERSONAL INFORMATION
Full Name:
Address:
City:
State:
Zip Code:
Phone (H):
Phone (W):
E-Mail:
ADDITIONAL INFORMATION
Name of church or group:
How did you hear about this seminar?
PAYMENT INFORMATION
How would you like to make payment? I Mail in a check Charge my credit card *** Call for my credit card information
Card Type:	VISA MC Amex Discover
Card No.:
Exp. Date:
Name on Card:

*** Your credit card information will be emailed to our office and then destroyed after processing. If you would not like your credit card information delivered via email please choose the "Call for my credit card information" option.

Isaiah 41:10

Fear not, for I am with you;
Be not dismayed,
For I am your God;
I will strengthen you,
I will help you,
I will uphold you with my rightous right hand.