Recognize Jerusalem Conference Registration Form
Kenlake State Park, Hardin, KY. April 6th-9th, 2017
First Name *
Your answer
Last Name *
Your answer
Spouse First Name
If Attending
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Country *
Your answer
Phone Number *
Preferably a cell that can receive text messages
Your answer
E-mail Address *
Your answer
Children's Names & Ages
ex: Joe 15, Mary 12, etc... (only those attending)
Your answer
Background *
Please tell us a little information about yourself, the church or fellowship you attend, how you heard about this conference, etc...
Your answer
I Will Pay With *
Any other information that would help us serve you? (Disabilities, food allergies, specific needs, etc...)
Your answer
Media Waiver
I hereby grant HaYovel complete and perpetual rights to use my likeness and voice in whatever media HaYovel has recorded such likeness or voice as the organization decides. I hereby release HaYovel from all liability and obligation to me, including credit, payment and/or any kind of monetary gain, concerning the use of any photos, video and/or voice that has been captured on any type of device.
Liability Agreement
I hereby certify that I am the person (or legal guardian of minor) whose name appears in the registration above. I understand that HaYovel leadership reserves the right to request my immediate dismissal from this event. If, God forbid, this happens, I will willingly comply with their request and any expenses incurred would be my responsibility to pay. I certify that all the information provided above is true and correct, to the best of my knowledge and belief. I accept the responsibility for my actions and the actions of my dependents traveling with me or traveling under my direction, and agree to not seek any redress, without limitation, against HaYovel or HaYovel personnel for any injury or harm that may result from my travel to and attendance at this conference.
Registration Fee: $50 for 18 yrs and up, $30 for 5 through 17 yrs, $250 Family Max - Late registration (March 6th) $75 Adult, $50 Children

Note: Registration fee covers speakers, packet, facility, sound, etc... it does not include meals or lodging.
Before clicking the "SUBMIT" button, please total your registration and go to and pay. Then click the submit button below to finalize your registration.
Never submit passwords through Google Forms.
This form was created inside of HaYovel. Report Abuse - Terms of Service - Additional Terms