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2019 Registration Form: ISEW
Please take a moment to complete the Registration form for the Ignite Student Evangelism Workshop hosted by the Long Island Church of Christ on Saturday, November 9th from 9am-8pm. The cost of this event is $60 per student.
First Name *
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Last Name *
Your answer
Gender *
Grade *
Age *
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Your Email Address *
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Your Cell Phone Number *
Your answer
Street Address *
Your answer
City *
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State *
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Zip Code *
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T-shirt Size *
Home Congregation *
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Youth/Family Minister Name *
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Youth/Family Minister Email Address *
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Youth/Family Minister Phone Number *
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Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Parent/Guardian Cell Phone Number *
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Parent/Guardian Email Address *
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Emergency Contact Name *
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Emergency Contact Phone Number *
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Are you currently taking any medications? *
Medication details
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Do you have any allergies? *
Allergy Details
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How will you submit payment? *
If other was selected please explain:
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