GREAT COMMISSION COURSE REGISTRATION FORM

Please complete and return with deposit and the indemnity form to secure your participation 1 January - 20 January 2010

Name: ______________________________________________________________________

Address: ____________________________________________________________________

State: ___________________________ Postal Code:_________________________________

Telephone: (h) ___________________ (w) _______________ (c) _______________________

Fax: _________________________________ E-mail: ________________________________

Occupation: ___________________________ Home Church: ___________________________

Do you believe in the Bible as the inspired, infallible and inerrant Word of God? ____________

Do you want to attend the whole course? 1 January - 20 January 2010_______ (Cost US$475)

Or only the Biblical Worldview Summit? 1 January - 8 January 2010 ______ (Cost US$200)

Signed: _____________________________________________ Date: ___________________

Please return completed form with 50% deposit to: Frontline Fellowship, PO Box 74, Newlands 7725, Cape Town, South Africa