Name*

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Provide home and/or work phone number*

Home Phone

Work Phone

Fax Number

Email*

Organization/Church

Check those that apply

  therapist

  pastor

  support person

  lay minister

survivor   

spouse of

Other 

Seminar attendees must read

and agree to the following:

"I understand and agree that the sponsors reserve the right to refund the registration fee and ask any person to leave who is perceived to be unable to cope with the material presented and/or whose presence is perceived to be a threat to others in attendance."

I have read the above statement and understand that by typing "I agree", I am accepting this condition as a prerequisite for attending this seminar presented by Restoration in Christ Ministries.

(Survivors are welcome but must be responsible

for their own well-being.)

Type "I agree" in this box :*

How many Seminar Notebooks do you want to purchase?  

Approximately 250 pages (recommended):  

        Enter number of Notebooks. $20 each

Special Advanced Mtg for Therapists & Prayer Ministers  $60**

Married Couple (both attending Special Adv. Mtg)

**Includes catered lunch

CEU Certificate  $55

Catered Meals (2)  $17  One Day Only  $8.50

Indicate Method of Payment

I prefer paying by Credit Card using RCM's Secure Online Service.

I prefer mailing a Check for my registration (and notebook) to RCM, PO Box 479, Grottoes, VA 24441-0479. Printable Registration Form. [Prior to Sept 23rd, you can send your payment by mail.]

Other (explain below)

Special Payment Instructions

Your confirmation letter (which appears immediately after successfully submitting this registration to RCM)

serves as confirmation of registration for the seminar.

Click Back Arrow in upper left to return to registration form

after printing confirmation letter.