Encounter Youth Conference Registration 2021
Date: July 31, 2021
Beginning at 9am
Abundant Faith Christian Center
2525 Taylor Ave, Springfield, IL 62703

For questions, contact Courtney Dandridge at courtneydandridge4@gmail.com
First Name (of Participant) *
Last Name (of Participant) *
Date of Birth (of Participant) *
What grade will the participant be going into? *
Emergency Contact First and Last Name and Relation to Participant (Example: Courtney Dandridge - Mom) *
Emergency Contact Phone Number *
Does the participant have any Dietary Restrictions and/or Allergies (use N/A if there are no Dietary Restrictions or Allergies)? *
Who Will Pick up the Participant (First and Last Name, Phone Number)? *
Participant T-Shirt Size *
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