Please note, this event is limited to pastors and ministry leaders.

Asterisks (*) denote required fields.
(Information obtained on this registration form will only be used for Briefing
purposes and will not be shared with any other organizations.)

Preferred Briefing Date*	<Select> March 13-14 April 17-18 June 12-13 Calvary Chapel
Have you ever attended one of our Congressional Pastors' Briefings?*	<Select> Yes No
First Name (as you would like it to appear on a nametag)*
Spouse Name (Note: Spouses are welcome to attend; however, do not indicate a spouse name unless they will definitely be in attendance.)
Last Name*
Title/Position*
Church/Ministry*
Church/Ministry Address*
City*
State*	<Select> Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Guam Puerto Rico Armed Forces Americas (AA) Armed Forces Outside Americas (AE) Armed Forces Pacific (AP) New Brunswick Newfoundland Alberta Northwest Territories Nova Scotia Prince Edward Island Quebec Saskatchewan Ontario Yukon Territory Manitoba British Columbia Other
Zip Code*
Church/Ministry Phone*
Home Phone
Cell Phone
E-mail Address*
How did you hear about the WallBuilders Pastors' Briefings?