NCYC Registration 2017 -- St. Clare Parish

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Please fill out this form so we may complete your registration with the National Catholic Youth Conference, which will be held Nov. 16-19, 2017, in Indianapolis.

Participant's first name *

Last name *

Preferred name for badge

Example: Matthew is first name and Matt is the name preferred for the badge

Mailing address *

City *

State (IL) *

Zip code *

Participant's cell phone *

Participant's email address *

Participant is adult or youth (under 21) *

select one

Adult

Youth

Participant's gender *

select one

Male

Female

Emergency contact name *

Emergency contact phone *

Participant's ethnicity *

select one

Asian/Pacific Islander

Black

Hispanic

Native American

White

Multi-Ethnic

Other:

Participant's special needs *

select one

Wheelchair access required

Enhanced listening device

Sign language interpreter

Large print program

Braille program

Scooter rental needed

Early stadium access due to mobility

Mobility assistance from stadium to convention center

Low gluten host

food allergies

None

Grade at time of NCYC *

Date of birth *

T-shirt size *

select one (adult sizes)

Men's small

Men's medium

Men's large

Men's XL

Men's XXL

Men's XXXL

Youth's Parent/Guardian information

Please complete this section for youth registration. Chaperones do not need to fill out this section, but do need to press submit button below.

Mother/guardian's name

Address if different from child

Mother/guardian cell phone or home phone

Father/guardian's name

Father/guardian address if different from child

Father/guardian cell phone or home phone

Press submit button

Your registration is not complete until you press the submit button.

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