17th BK Registration Form July 15, 16, & 17, 2011 "Living the Promises" (Simply print out this form, fill it out completely, and mail it in.)

Name________________________________________________________ Address_____________________________________________________ City, ST, Zip_______________________________________________ * PREREGISTRATION __________ x $ 5.00 = __________ * After July 1*************__________ x $ 8.00 = __________ * REGISTRATION TOTAL*********************= $__________ * Tee Shirts ( S -- M -- L -- XL ) ________ x $12.00 = _____________ * Tee Shirts ( XXL -- XXXL ) ________ x $14.00 = _____________ * SHIRT TOTAL = $_____________ TOTAL ENCLOSED: $____________________ Make check payable to: Greg Bradford 2517 East Avenue J-2 Lancaster, CA 93535