Uprising 2016 Registration
Please Register For Uprising Below!
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First Name *
Last Name *
Email Address *
Zip Code *
Phone Number *
Sex *
Date of Birth *
MM/DD/YYYY
Current Education Level *
What church are you from?
Are you an adult youth group leader?
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Do you have any dietary restrictions? If yes, please state below.
Parent/Guardian First & Last Name (If you are a minor)
Parent/Guardian Contact Number
if you're a minor, you must provide!
Are you interested in staying with a host family? *
If no, do you plan on staying at a hotel during the conference?
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Will you be joining us for our BBQ on July 3rd after our Sunday Celebration? *
Submit
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