CEA Membership Form

Christian Education Association

Last Name _________________________ First Name ____________________

Name of Spouse ___________________________________________________

Home Mailing Address ______________________________________________

City _________________________ State ________________ Zip___________

Daytime Phone _____________________ Evening Phone __________________

Email Address _____________________________________________________

Name of Church Family _____________________________________________

Church Mailing Address _____________________________________________

City _________________________ State ________________ Zip___________

Church Web Site Address ____________________________________________

Ministry Position / Church Role _______________________________________

Would you like to be added to the CEA Email List Forum? ____ Yes ____No

(the above email address will be used unless another one is provided)

Membership Fee: $30

· A paid fee of $30 gives you membership privileges for the calendar year

· When you attend the yearly conference, membership is automatic for that year since the membership fee is included in the conference fee

· Please make your check payable to “CEA”

Please send completed registration and payment to:

Walton Hook

Bentonville Church of Christ
904 NW 8th St.

Bentonville, AR 72712

If you have any questions, call or email Walton using the below information:

Phone: (479) 273-2178