Whatever It Takes - A Life Changing Conference for Couples

Last Name:
First Name:
Street Address:
City:	State:
Zip Code:	Phone:
Email:
Age:
Gender: Male Female
*Person you would like to room with (First and Last Name):*
Paying $50.00 deposit by: Credit Card: (Someone will contact you.) Check: Make check out and mail to: Verity 11850 Brookville Rd. Indianapolis, Indiana 46239
If you are flying into the Indianapolis Airport, will you be in need of airport shuttle ($25.00 per person for round-trip shuttle) Yes No *If yes, please provide the following:*
*Airline:*	*Flight Number:*
*Arrival Date:*	*Arrival Time:*
At the conclusion of the WIT Conference, you will be given a WIT polo shirt. Please provide us with your shirt size: Men's: S M L XL 2XL Women's: S M L XL
Comments, Questions or Concerns:

SINGLES CONFERENCE REGISTRATION