Associates in Christian Counseling

Tuesday, April 10, 2012, 6:30 p.m.
Benton Convention Center, Winston-Salem, NC
Featuring Judy & Harold Smith
President & CEO, Christianity Today International

RESERVATION DEADLINE APRIL 2nd

* Required Fields

Ticket Prices*

Individual ($50)

Table Sponsorship ($300) includes 8 tickets and program acknowledgement

Higher level sponsorships, including additional benefits, available for individuals and businesses.
Call 336-896-0065, ext. 305 for details.

Total number of tickets purchased*

PAYMENT: Our staff will contact you to arrange for payment by check or credit card.

Your Name*

Address*

City*

State*

Zip*

Primary Phone*

Secondary Phone

Best Time to Call

Email Address*

Spouse or Guest Name*

Name(s) of your guests*

Do you subscribe to the ACC's E-Newsletter?*

Yes

Sign me up!

If you are having difficulty with this registration, please call 336-896-0065, ext. 305