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DYING TO LIVE SUMMIT REGISTRATION FORM

First and Last Name *

Address *

Phone Number *

E-mail Address *

Age *

Gender

How did you hear about the Summit? *

What day(s) will you attend? *

Day One

Day Two

Did you attend last year’s Summit? *

WHAT CHURCH DO YOU ATTEND?

Would you like to participate in this year’s Talent Hour? *

If yes, please enter the solo/group name:

What talent will you perform?

Requests/Comments?

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