Name (As you’d like it on your name tag) *

Full Mailing Address. Please include Street, City, State and Zip Code *

Email to use for Conference communications *

Cell Phone *

I am... *First time attenderAlumni

Please indicate your check in/check out time, such as "Arrive on time, leave Sunday morning after attending the church service". *

Do you expect to arrive in time for dinner on Wednesday? *

Do you have any diet restrictions? Yes, no. If yes, describe: *

I prefer my room to be located:The quiet hallThe social hallWherever you place me 🙂

How did you hear about this conference? *

What are you hoping to gain from this conference that would make you feel like it was worth the investment? *

Have you facilitated or taken one of our courses? If so, which one(s)? *

Have you been coached by us? If so, who is/was your coach? *

Are you married or single? If married, how many years?

Do you have children? If so, what age? *

Emergency Contact: Name & phone number of someone we can call if there’s an emergency situation while at the Conference *

Please read the following statement. Type your name in the text field to indicate your agreement. We will get your hand signature at the Conference check-in: This program is designed to provide methods, ideas, training and education including enhancing your relationship with God. Due to the uncontrollable aspect of the Holy Spirit, your facilitator, class assistants, Greater Impact Ministries, Inc. (GIMI), Nina Roesner, and the host organization make no guarantees of any specific life change as a result of your participation in one of our programs. Specific relationship advice given to participants is the opinion of the facilitator. GIMI facilitators are NOT licensed counselors and do not represent GIMI in such a capacity. GIMI staff, facilitators, and volunteers are held harmless as well and are unauthorized to give advice. GIMI is held harmless for any facilitator, staff, or class assistant actions. Participants should rely on their own relationship with God and the direction of the Holy Spirit as to specific application of the Bible to their individual lives. This course does not guarantee happiness or relationship improvement and is designed to encourage participants to move forward in their relationship with God. Individual results may vary. I understand that photos taken during class may end up on social media sites like Facebook®. I hereby hold harmless and release and forever discharge GIMI from all claims, demands, and causes on my behalf or on behalf of my estate. I am 18 years of age or older and am competent to contract in my own name. I have read this release, and I fully understand the contents, meaning, and impact of this release. By typing my name below (required for attendance), I agree to these terms. *

Please read the following statement. Type your name in the text field to indicate your agreement. We will get your hand signature at the Conference check-in: VIDEO & PHOTOGRAPH RELEASE: The undersigned does hereby consent to the photographing and videotaping of all conference activities by Greater Impact Ministries and its successors and assignees, to cause the resulting photographs to be sold, exhibited or otherwise used, for purposes of advertising, trade or otherwise, as still photographs, motion pictures, television, website or other media or means of reproduction, transmission or exhibition. The undersigned does hereby release Greater Impact Ministries, Inc., its employees, agents, associates, successors and assignees, from any and all claims for damages or compensation or libel, slander, invasion of the right to privacy, or any other claim based on the use or sale of said material. The undersigned does hereby waive any right to inspect, approve or edit said material or any descriptive or advertising material used in connection therewith. *

Is there anything else you‘d like us to know, such as I’m bringing chocolate for everyone *wink*?