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Chaplains Conference Registration
Chaplains Conference Registration Form
Personal Details
Your First Name
*
Your Last Name
*
Preferred Name
Agency/Organization
*
Current Position
*
E-mail
*
Work Phone
*
Cell Phone
Dietary Restrictions
-- select --
Vegetarian
Dairy-Free
Gluten-Free
None
Other...
Are you currently a member of the COG Public Safety Chaplains Committee?
Yes
No
Would you like to be a member of the COG Public Safety Chaplains Subcommittee?
Yes
No