* Full Name (as it appears on passport)

Name You Prefer

Title You Prefer (Mrs, Dr, Rev, etc.)

* Email Address

* Permanent Address

* City

* Country

* Gender (For Room Assignments)
Male
Female

Date of Birth
-- Month January January March April May June July August September October November December -- Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -- Year 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

*Church Affiliation

*Occupation

*Employer

*Work Profile
Please tell us more about your work and your community. Include anything you want us to know about you.

*Area of Interest
Please select your primary are of interest for this year's conference.
-- Choose One Theology Economics Conversations for Practitioners

Which Previous Amahoro Gatherings Have You Attended?
(please check all that apply)
Uganda 2007
Rwanda 2008
South Africa 2009
Kenya 2010
Kenya 2011
This is my first Amahoro Gathering
All first-time attenders are required to arrive by noon on Monday for the Amahoro Orientation Session. More details will be included in your registration confirmation letter.

*How did you hear about Amahoro?
If through a friend, please include that friend's name.

Emergency Contact

Medical

Please Describe your current state of health

Please list any allergies and reactions,
illnesses, recurring health problems, dietary
concerns or other limitations

* Please Select Your Method of Payment
The registration fee of $900 covers all accommodation, meals, conference fees and transport within Burundi. Airfare is not included. A minimum deposit of $300 is required to secure your attendance. The balance will be due on or before March 1, 2012

Paypal (transaction fees will apply)
Send a U.S. Check

Once registration is confirmed, we will contact you regarding travel arrangements. Please do not book your flight until you have confirmed the details of your visit with the Amahoro team.

I have read and agree to the above statement.*