Prayer Tower Church of God in Christ

Pentecostal Assemblies of the World Region 3 ICEA Registration Form

	Profile Information
	Name:
	Address:
	City:
	State:
	Zip:
	Telephone:
	Mobile:
	Email Address:
	Emergency Contact Name:
	Telephone:
	Mobile:
	Church/Jurisdiction Information
	Church Name:
	Church Address:
	City:
	State:
	Zip:
	Pastor:
	Jurisdictional Bishop:
	Please check all that apply:	Church Registration ($50.00) Adult Registration ($25.00) Children Registration(18 & up) $12.00 GTSC HACC MDC MWDDC
	Quantity:	Church Adult Children



OR Download the registration form here.

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ICEA

International Christian Education Auxiliary
of the P.A.W.