SALT 2022 Registration Form
Every January we join together with other Chi Alpha's across the Midwest for an unforgettable three-day conference called SALT. It's a time full of incredible worship, teaching, breakout sessions and growing deeper in our relationship with the Lord. This year’s focus is on Transforming the University! Join us as we travel to Lake Geneva Christian Center in Alexandria, to hear from missionaries who will inspire and encourage you to live out your faith now and beyond.

When: January 14th - 17th
Location: Lake Geneva Christian Center // Alexandria, Minnesota

Cost:
- Before Dec 16th: $155
- After Dec 16th: $175
- Down payment: $90 due by Dec 16th.

For more info contact:
Brian Ziolkowski
651-324-5604

https://www.greatplainsxa.com/gp-salt
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Email Address *
Phone Number *
Gender *
Classification (Student, Staff, or Alumni) *
What year will you graduate? (If already graduated, list the year you graduated) *
Emergency Contact *
Emergency Contact Phone Number *
Who's small group are you in? *
Would you like to be in the carpool plan? *
If yes, what time can you leave on Friday, January 14th?
Are you able to drive? *
If yes, how many people can you drive? (Including yourself)
List any food restrictions you have *
Payment type *
Please initial below to agree to the following: I understand that my registration is not complete until I have paid for SALT online (link given on the submission receipt of this form) or by cash or check to an XA Staff person. *
PLEASE READ THE WAIVER BELOW BEFORE SIGNING YOUR INITIALS: In consideration of being allowed to participate in any way in the Great Plains North Chi Alpha SALT, I understand and acknowledge that this Waiver and Release discharges Great Plains Chi Alpha and UMD Chi Alpha from any liability or claim that I, the attendee, may have against Great Plains Chi Alpha and UMD Chi Alpha with respect to bodily injury, personal injury, illness, death, or property damage that may result from my activities and time spent at the Great Plains Chi Alpha SALT. I also understand that Great Plains Chi Alpha and UMD Chi Alpha does not assume any responsibility for or obligation to provide financial assistance or other assistance to me, including but not limited to medical, health or disability insurance, in the event of injury, illness, death or property damage. I also grant to [Great Plains Chi Alpha & UMD Chi Alpha], its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize [Great Plains Chi Alpha & UMD Chi Alpha], its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that [Great Plains Chi Alpha& UMD Chi Alpha] may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy