First Name:
Last Name:
Mailing Address:
City/State/Zip:
E-Mail Address:
Church You Attend:
Your Pastor's Name:
Age:
Parent/Guardian Name:
Parent/Guardian Phone:
Chaperone's Name:
Mail Check or
Credit Card
Payment Method:
 PayPal
Online Registration Instructions:

Registration $75

1.  Fill out the form and click "Submit"  
(Only one entry per person please)

2.  Use PayPal button to submit  payment
(Please add an additional $3.00 processing
fee for each person)

Payment must be received in order to be
registered.

Chaperones: Please print and mail the Chaperone
form to register.  Do not register with the on-line form.


( If you have trouble with PayPal, you can come back to
this page and simply choose the PayPal button to try
again.  Do not fill out form again)
WASHINGTON DISTRICT
YOUTH CONVENTION 2010
ONLINE REGISTRATION FORM
  • If you are using PayPal, please enter the names of the registrants
    when reviewing your payment in the "Name" area provided.
  • If you register on-line, please bring a signed Registration form with
    you to Conference.
Payment Examples:

1 person: $78.00
2 people: $156.00
3 people: $234.00

Enter amounts in unit price in PayPal