YSA Conference Registration

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Longview Texas Stake
Trip to Nauvoo, Illinois
May 31- June 4, 2025

Full Name *

Senior's Phone Number

Gender *

Shirt Size (all sizes are adult; special request will be honored if requested on time) *

Guardian's Full Name *

Guardian's Phone Number *

Emergency Contact *

Emergency Contact's Phone Number *

If applicable please list medical insurance information (insurance company, policy holder,
group #, name on policy, etc.)

List all over the counter and prescription medications taken by the young adult.

Are there any allergies?

Any special dietary needs?

Submit

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