2019 Youth Conference Registration
Questions Contact: Sister Stacy Jackson @ 801-540-7247 or email @ dsjhpjackson@gmail.com
First Name *
Your answer
Last Name *
Your answer
Are you a youth or adult? *
Birth Date (if you are a youth)
MM
/
DD
/
YYYY
Ward *
Your answer
Phone Number *
Your answer
Youth's Email
Your answer
Parents Email
Your answer
T-shirt Size *
Do you need housing? *
Preferred Roommate (if you need housing)
Your answer
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