Middle School Youth Gathering Registration Form 2021

Please fill out this form and click submit.

November 5-7, 2021
Speaker: DCE Emilie Stooksbury
MC: Wesley Wright
Band: TBD
Cost and Registration: $200.00 if registered by Oct 1, 2021
($225 until October 15th when registration closes)

The 2021 Middle School Youth Gathering will be held at the Lake Yale Baptist Conference Center in Eustis, Florida.

Youth Name

*

Grade

*

Please select one option.

6th 7th 8th

T-shirt Size

*

Please select one option.

Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL

Roommate Request (not guaranteed)

Parent Name

*

Chaparone

*

Please select one option.

I am not able to go as a parent chaperone. I am willing to go as a parent chaperone and I am willing to drive. I am willing to go as a parent chaperone and I am not able to drive.

Parent Email

*

This address will receive a confirmation email

Emergency Contact Phone During Event:

*

Address

*

Payment

Pay $200.00 Cash or Check to Church office (0) Before or on Oct. 1 ($200.00) After Oct. 1 ($225.00)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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