Youth Convention Registration

Please fill this form out completely. If you do not you may be redirected back. It is district policy that refunds are only given in emergency situations but that DOES NOT include an administrative fee of $10 per registration. Our offices are located at 2600 I-70 Drive NW Columbia, MO 65202. You can call us at 573-445-3611. Please note Youth Convention event registration cost. Pre-registration is $38 per person and is due by Sept 14th (postmarked). Early registration is $40 and is due by October 14th (postmarked). Event registration is $45 due by October 28th (postmarked). After the 29th the cost is $49 to register.

T-shrit Registration

Church Name and City *

Youth Pastors Name *

First Name *

Last Name *

Street Address *

City *

State

Zip Code *

Age *

Student Cell Phone *

Emergency Contact Phone Number *

Email Address *

Is student a diabetic?

No
Yes

Any thing else you would want us to know? *

* indicates required fields

Web form by