Personal Information
Fields marked with * are required.

First Name* Last Name*
Street Address*
City* State* Zip*

Contact Information
Home Phone* Cell Phone
Email
Church/Organization Name (if applicable)
Do you pastor at the church you attend?  Yes No

Emergency Contact Information
First Name* Last Name*
Home Phone* Cell Phone

How did you hear about EMERGE?
 Mailer Poster BSC Service BSC Life Group Internet Facebook Friend Other

Would you like to sponsor someone to attend EMERGE?
Your sponsorship will go toward someone who is not able to go for financial reasons. Please indicate the amount that you are donating. You may submit your donation in Step Three of this form.

Room Reservations
Bay Summit has arranged to have a special block of rooms reserved at the newly appointed Renaissance ClubSport Hotel for our women during Emerge. These rooms are available through direct booking with the hotel and include daily breakfast, gym facilities, and spa usage. Rooms start at $35 per person per night for quadruple occupancy and go up to $119 per person per night for a single occupancy room. To reserve your room, please call Renaissance Reservations at 925-938-8700. We encourage you to stay and experience all the relaxation and refreshment that this weekend has to offer.

Refund and Cancellation Policy
All reservations are non-refundable after February 19, 2010.

Required:
I understand that by submitting this form, I agree to the refund and cancellation policy.