Messy Church Training- Online - March 13, 2021 Use this form to register as a team or individual for the training on online on March 13, 2021 sponsored by the Diocese of Southern Virginia. Date: March 13, 2021 Time:9:00 am to 2:30 pm ET(with breaks in-between) Where: Online link provided to registrants. Local Contact: Lynn Farlin firstname.lastname@example.org, or 757-213-2277 Cost: Individual $ 45.00 Group of 2-4 $ 130.00 5th person and over—Additional $ 10.00 per person Total number of attendees you are registeringPlease include yourself123456789Is your church currently involved in Messy Church?*YesNoChurch Name*Church Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Church Email (optional) Your Name*If you are registering a group, you will be the group contact First Last Your Email Address* Your Phone Number*Attendee #2 Name* First Last Attendee #2 Email* Attendee #3 Name* First Last Attendee #3 Email* Attendee #4 Name* First Last Attendee #4 Email* Attendee #5 Name* First Last Attendee #5 Email* Attendee #6 Name* First Last Attendee #6 Email* Attendee #7 Name* First Last Attendee #7 Email* Attendee #8 Name* First Last Attendee #8 Email* Attendee #9 Name* First Last Attendee #9 Email* Individual Registration Price: $45.00 Group (2-4 Registrants) Price: $130.00 5+ AttendeesAfter 4 attendees, each person is an additional $10.00. Price: $0.00 Tracking CodeIf you have been given a tracking code to register as part of a larger organization (like your Conference), enter it below, and click apply. Total $0.00 Credit Card Card Details Cardholder Name EmailThis field is for validation purposes and should be left unchanged.