Full WDAG 2023 Registration

Last Name*

First Name*

Email*

Street Address*

City*

ZIP Code

State*

Country*

Mobile No.

Birth Date*

I am: Deaf/ Hard of hearing/ Hearing/ Deaf-Blind*

Are you Pastor? Yes No

Church Name

Senior Pastors Name

Wheelchair or mobility disability? Yes No

Will you have travel insurance? Yes No

Do you need a table for display? Yes No

Will you be involved in our afternoon of theatre/drama? Yes No

Dou you need special food? (Please describe)

Do you have allergies? (Please describe)

What name do you want on your name tag?

Dou you want to lead worship? Yes No

Flight information (Airline and flight numbers)

Passport Number

Visa?

Time of Arrival (Date & Time)

Time of Departure (Date & Time)

General Comments

Number of Childrens 0-1 (Free - No Charge)

Childrens 0-1: Name, Special Food Needs, Allergies, Shirt Size, Tag Name.

Childrens 2-12: Name, Special Food Needs, Allergies, Shirt Size, Tag Name.