Registration is for Senior Pastors Only. Please complete all information.

Title:
Pastor's First Name:
Pastor's Last Name:
Spouse First Name with Title:
Is your spouse attending the conference?	Yes No
Are you an AIM Member?	Yes No
Is this your first Pastor and Spouse Conference?	Yes No
Will your children ages 16 and up, be attending the conference?	Yes No
How many children will be attending?:

Home Address:
City:	State: Zip:
Home Phone:	(  ) -
Church Name:
Church Address:
City:	State: Zip:
Church Office Phone:	(  ) -
Church Fax:	(  ) -
Email Address:
Referred By: