Life and Godliness

Conference Registration

Downloadable Form

Use the form below to sign up for the Counseling and Discipleship Conference being held on Feb 5-6, Feb 19-20, Mar 5-6 on the Campus of the Southeastern Indiana Baptist Association. Read the conference details page for more information.

* = required field

First Name:

*

Last Name:

*

Address Line 1:

*

Address Line 2:

City:

*

State:

* Choose: ------------------------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussetts 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

Zip Code:

*

Phone:

*

- ex: 555-555-5555 ext 1234

Email Address:

*

Confirm Email:

*

Registration Type:

* Choose: ------------------------- Individual rate ($175) Couple rate ($300)

Spouse's Name:

* = required field

Payment Location

Please indicate where you will be sending your payment:

Dr. Scott's box in the School of Theology office at SBTS

Center for Biblical Counseling, Box 1000, 2825 Lexington Rd, Louisville, KY 40280

SEIBA, 615 Park East Blvd, New Albany, IN 47150

* = required field

Registration Reminders

• Online registration does NOT guarantee your spot for the conference. To reserve your spot, we must receive your payment.
• Please make your check out to SEIBA.
• Questions? Contact Emily Chambers: echambers@sbts.edu or 502.897.4608