Youth Conference Registration Form

Please be sure to fill this form in completely. While some information is required, all of the fields are important, so please be thorough and accurate. If you do not know the answer to one of the questions, state "unknown".

Do not use the following characters ( . " , )

You will have another opportunity to complete registration when you arrive at the conference. All attendees will be required to check in, however, by filling out this form, you allow us to have your materials and possibly room assignments available ahead of time, thus facilitating the process. Your conference fee will be due when you check in.

Enjoy the conference, and keep open to the will of the Lord in your life.

Your Name (First Middle Last) (required)

Street Address (required)

City (required)

Province (required)

Postal-Code (required)

Phone (required)

Your Email (required)

Church Affiliation (required)

Date of Birth (mm/dd/yyyy) (Required for Youth)

Age as of April 1 (this year .. Youth Only)

Have you been to a previous
Youth Conference at Victory Baptist Church ?
YesNo

Gender
MaleFemale

Emergency Phone Number (required)

Emergency Contact Name

Subject (Required)

Medical Problems (including Allergies)

Motel Room Required?
YesNo

Room-mate Request (List Three (Youth Only) .Subject to Availability)

Check one
YouthSpeakerLeaderPastor