Adoption & Orphan Ministry
Name(s)
Email Address
(required entry)
Phone Number
Childcare Needs
(Childcare is available for children birth through 5th grade)
Names DOB
(First Last) (MM) (YYYY)
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2.     / 
3.     / 
4.     / 
5.     / 
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Number of attendees
(not including children in childcare)
Will you be...?
(check all that apply)		 Attending
Volunteering
Speaking at a Breakout Session
Representing an Agency or Organization
Are you married or single? Married
Single
Your city of residence
Do you attend church? Yes
No
If so, where?
How did you hear about this conference? (Check all that apply) Email from LPC member
Agency
Web search
Facebook
Radio
LPC announcement
Newspaper
Word of mouth
Other
Are you? (Check all that apply) Investigating Adoption
In the process of adopting
Post-adoption
Investigating Foster Care
Becoming a foster parent
Currently a foster parent
Do you have any special needs or comments?
What do you hope to gain from attending this conference?


Having difficulty registering? Please contact the ministry team
and let us know. We will try to resolve the issue as soon as possible. Thank you.