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ATTENDEE REGISTRATION: Aug, 9-11, 2023
*** We will send registration and event details via email, please leave accurate email address ***
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This is an image of our "Accountability Decal" for use on: Screens, Refrigerator Doors, Beer Glasses or wherever you might want some extra accountability.... Or just because they look good & having a reminder of your Encounter & Jesus near is cool!
Name
*
(First Last | i.e. John Smith)
Your answer
Address
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(Street, City, ST, Zip)
Your answer
Phone
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3082930632
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Spouse or Additional Contact
*
We would like to speak with your spouse, family, and/or friend(s) 2 weeks before Encounter to ask them to pray for and encourage you. Please provide one contact below. Spouse is preferred.
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Spouse or Additional Phone
*
3082930632
Your answer
Spouse or Additional Contact Email
*
Your answer
From what church will you gather to Launch your Encounter weekend?
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Kearney
Lexington
Moses Hill Church-Loomis, NE
Valentine
North Platte
Leadville, CO
Shirt Size
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XS
S
M
L
XL
XXL
XXXL
XXXXL
XXXXXL
The cost of Attendance is $150, payable online or at the door. Our desire is that no man would miss out due to financial hardship. For this reason, scholarship money is available for those in need. Would you like to discuss
partial
scholarship options?
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No
Yes
Who invited you?
*
Your answer
Person's email who invited you:
*
If you don't know their email, use
nebraskaencounter@gmail.com
Your answer
IF... you regularly attend, what church do you call home?
Your answer
Do you have any significant food or medical allergies or special needs?
For example: need wheelchair access, diabetic diet, food allergies, cannot climb stairs, bottom bunk, etc.
Your answer
Preferred Beverage (Select up to three)
Water
Coke
Pepsi
Mountan Dew
Dr. Pepper
Root Beer
Coffee
Iced Tea
Diet Coke
Diet Pepsi
Gatorade/Powerade
Other:
A copy of your responses will be emailed to the address you provided.
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