Print Registration Form

PLEASE PRINT CLEARLY FOR SHIPPING

NAME:____________________________________________________

ADDRESS:_________________________________________________

CITY:____________________________STATE:________ZIP:________

PHONE NUMBER:(___)______________________________________

Age
Male
Female
Married
Single
Separated

___
___
___
___
___
___
___

Date_______

Name of Conference______________________________________Dates_____________
_I have already registered by e-mail on (date)_________
____ I will be attending the conference with my spouse_____________________
____ I will be attending the conference and desire to share a room with the following person(s)
(Please note that both roommates must make the same request)
__________________________________________________________________________________
How did you hear about this conference?_________________________________________
Have you attended a McLean Ministries Conference? _______________________________
Are you presently involved in healing and/or other ministry?___________________________
Are you currently seeing a professional, pastoral, or lay counselor?______________________
If yes, for how long?___________ For what reason ?_______________________________
Name and addresses of two people willing to serve as references.
1. _____________________________________________________________________
2._____________________________________________________________________
Advise of any special health condition:i.e. HIV virus, diabetes, etc.______________________
List any medication you are currently taking: ______________________________________
Are you in any way interested is spiritualism or the occult, i.e. transcendental meditation, astrology, horoscopes, etc.? Yes___ No ___ Are you willing to give up these interests?_____
Write a short paragraph on the back of this sheet about your past and/or present concerns for which you seek healing and include it with your check and application.

Include a minimum of $150 per person (check or money order in U.S. dollars) with this form.
Deposit is Non-Refundable
Early registration saves $50
(see each conference information for dates)
Return application and check payable to:
McLean Ministries
P.O. Box 5187
Hickory, NC 28603
Please feel free to duplicate this application for others desiring to attend.
Questions: 828 322-5402

Complete conference:

Less Deposit
(Minimum $150 per person)

Total

Balance due upon arrival

$__________

$__________

$__________

$__________