Impact Celebration 2023 Registration Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Church/Organization (if applicable) Email* Phone* Yes, please sign me up for the Impact Celebration Tickets to this event are free!We hope you can make an optional donation to support this special event and all of JustFaith Ministries' programs by choosing a gift amount below. Thank you for your support! $10 $25 $50 $100 $250 $500 Other Other donation amountThank you for your support! Total Donation $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Yes, please sign me up for JustNews, monthly e-newsletter from JustFaith Ministries. NameThis field is for validation purposes and should be left unchanged. Δ
