PMRV 2019 Triennium Registration
Please complete the following registration information for Presbyterian Youth Triennium, July 16-20 at Purdue University
Email address *
First Name *
Your answer
Last Name *
Your answer
Preferred Badge Name
Your answer
Identifying Gender *
Your answer
Birthdate *
MM
/
DD
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YYYY
Church
Your answer
Role: Are you interested in being a... *
Do you have any special needs (physical, diet, etc.)?
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Primary Phone Number *
Your answer
T-shirt Size * *
Requested Roommate (not guaranteed)
Your answer
A copy of your responses will be emailed to the address you provided.
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