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Youth Workers Conference Registration

Individual Registration Form

Are you registering as? [Select one]

Youth Worker (Pastor, lay leader, volunteer, social services worker, etc.)

Student Leader (High school age leader in youth ministry)

Messiah College student

Contact Information

Name:

If you are a Messiah alumnus/a, provide class year:

Home Street Address:

Home City:

Home State:

Home Zip Code:

E-mail Address:

Phone Number:

Ministry Title or Position:

Church/Organization Name:

Church/Organization Street Address:

Church/Organization City:

Church/Organization State:

Church/Organization Zip Code:

Size of youth group [Senior High age]

Session Information

Please indicate the workshop sessions you wish to attend:

Workshop #

Moring Session

Afternoon Session

Are you planning on attending the evening concert?

Yes No

Total Due:

Payment Information
Make Check Payable to Messiah College

mail check

credit card