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CROSSROADS COUNSELING
Seminar Registration

"Hope & Restoration After Sexual Abuse"

Please complete one online registration per individual or couple. If you are submitting several registration and plan to pay for them with one credit card please contact the Crossroads office at (706) 364-1270 and speak with Brad Hambrick. Your information wil be used for the purposes of this seminar only and will be sent via secured connection. You may call the Crossroads office for more information or to register by phone.

Thank you and we look forward to seeing you at the "Hope & Restoration After Sexual Abuse" seminar.

 

*All fields must be completed to ensure proper registration.

 

Name(s)

 

Street Address

 

City      State     Zip Code

 

Phone Number    E-Mail Address

 

Church Membership

 

How did you hear about the conference? 

  

    Ticket Prices: 

 

         Individual                    $20.00                         

         

 

Number of Tickets: Session:

Method of Payment:       

* If paying by postal mail, please complete this form and mail check to 3665 Wheeler Road, Suite 1B Augusta, Georgia 30909

 

Name on Card:

Credit Card Number:  (example 1234-5555-1212-7777)   

Expiration Date:  (example  mm/yyyy) 

Total Amount:

 

Special Comments:

 
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