Registration Form

Please Fill Out & Submit This Form for Registration.
Last Name (Surname) *
First Name (Head of Household) *
Spouse Name
Number of Children Attending *
Names and Ages of Attending Children
Address 1 *
City *
State *
Zipcode *
Phone #
Email *
Church Affiliation
Church Leader?
Will you entering the Scripture Art Contest?
(3 entry limit per person)
(More Info)
If yes, please describe the Scripture Art entries:
Will you be entering the Photo Contest?
(More Info)
If yes, what are the dimensions of your photos?
Would you like to be a Celebrate the Glory Representative in your church and community?
(More Info)
How many lunches would you like to order?
($5 per person paid at event check-in--More Info)
Will you be joining us for Sunday Worship?
(10am-11:30)
How did you hear about Celebrate the Glory?
If you need further assistance...

Call 434-660-7729 or Email Marc Jantomaso