Street Preaching Conference Registration Form Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) Home Church(Required)Will you need either/both of the following?(Required)If you would like us to provide housing, please plan on bringing your own bedding and toiletries. Housing MealsSelect AllPlease list any dietary restrictions belowWhat day do you plan to arrive?(Required) MM slash DD slash YYYY What time do you plan to arrive?(Required) Hours: Minutes AMPM AM/PMAre you flying in for the training week?(Required) Yes No, drivingWe will have an airport pick up Thursday (May 26) at 3PM at the Atlantic City Airport. Please schedule your flight accordingly and list your flight information belowPhoto Release Form I agree to the privacy policy.The Presbytery of New Jersey Boardwalk Chapel 220 E. Hand Avenue Wildwood, NJ08260 Permission to Use Photograph I, the undersigned, do hereby grant THE PRESBYTERY OF NEW JERSEY (Boardwalk Chapel in Wildwood, NJ), its representatives, employees and agents the right to take photographs of me, my children and my property in connection with any Boardwalk Chapel related event, including but not limited to worship and/or church services, nightly programs, chapel picnics and meals, chapel bible studies, including and special training sessions or seminars, and any other event in which I, or my children may be present in connection with a Boardwalk Chapel Wildwood, NJ event, whether a chapel sponsored or chapel involved event. I agree that The Presbytery of New Jersey (Boardwalk Chapel in Wildwood, NJ) may use such photographs of me and my children with or without my name and for any lawful purpose, including but not limited to uses for publicity, illustration, advertising, website content and the like. I have read and understand the above, and I acknowledge that by signing below I do hereby grant permission and consent for the use of my and my children’s likeness as described herein above.If you are under 18, please provide the name, phone number, and email of your parent/guardianNote: Payment can be sent to: Douglas Hoogerhyde, CPA PNJ Missions 886 Belmont Ave., Suite One North Haledon, NJ 07508-2566 Please indicate on the check that the money is for your participation in training weeks.
