Love and Respect Registration Form

Complete this form to register for the "Love and Respect" video conference. You may want to write down the address below before you submit the form.

First and Last Name     

Mailing Address           

City, State, Zip Code   

Phone Number            

Email Address            

Please send checks by February 4th for the early bird rates of $15 for individuals and $30 per couple.

"At-the-door" rates are $20 for individuals and $40 per couple.

Checks are payable to "Evangelical Covenant Church" and send to:

Evangelical Covenant Church
RE: Love and Respect
5405 Hart Lane NW
Bemidji, MN 56601