Registration opens January 6, 2014.
* Last Name
* First Name
* Email address
* Phone Number (no dashes or spaces between numbers)
Alt. Phone # (cell)
* Address
Secondary address
* City
* State
* Zip
Organizational affiliation - School, church, or ministry name (if applicable)

Payment Information
* Which payment scale do you plan to use?
Standard rate: $65/person
Student rate: $15/person

Breakout Session Registration
I would like to register for the following breakout session on Saturday, 2:15 pm (choose one):
Creation, Evolution, and Public Policy - Dr. Michael Farris, Chancellor, PHC
The Latest Research on Earth's Habitability - Dr. Guillermo Gonzalez
Faith and Science: PB&J or Oil and Water? - Dr. Michael Kucks
Evidence for the Supernatural from Human Consciousness - Dr. Robert Spitzer
I am a (please check one) and will be attending the Friday morning special session.
Pastor ("Pastoring a Scientifically Literate Congregation")
Student ("My Humanist Science Teacher and Friends Think I'm a Kook")
How did you hear about the conference?
Church or school announcement
Word of mouth
Print mail announcement
Online ad
Other :  
I would like to be added to these mailing lists.
Patrick Henry College
Pensmore Foundation

Note: All registrants will automatically be added to the conference email list

Upon submission of this form, you will be directed to another page where you will submit your payment information. Once we receive payment, your registration will be complete.

* required