Full Name:

Date:

Last

First

M.I.

Spouse
Full Name:

Last

First

M.I.

Address:

Street Address

Apartment/Unit #

Street Address

City

State

ZIP Code

Phone:

Email:

Please print out this document for each individual or couple. Please pay with a check or money order mailed to mailed to this address: Deaf Biblical Counseling, Inc., C/O DBC23 Conference, PO Box 292, Danville, KY 40423-0292. We have other purchase methods available. Please email DeafBiblicalCounseling@gmail.com or call (859) 755-4574 to discuss other payment options. The price of your registration will be based on the purchase date or the post mark date on the envelope.

We currently have an agreement with Comfort Suites, 864 Ben-Ali Drive,
Danville, KY 40422-1927. If we get 20 people to call their office at (859) 936-9300
to reserve their room using our registration code “DBC23”. The price will be reduced
from $156 a night to $140 a night. This needs to be done ASAP.

I certify that my answers above are true and complete to the best of my knowledge.

If there were any problems with the calculations, a DBC Conference representative will reach out to you to explain the issues over a phone call prior of the event or at the conference.

Signature:

Date: