Event Registration Form

//Event Registration Form
Event Registration Form 2018-06-18T04:27:09+00:00

*Fields required

Your Information

First Name *

Last Name *

Name as you would like it to appear on name badge *

Email *

Cell Phone * (xxx-xxx-xxxx)

Address *

City *

State (scroll for selection) *

Zip *

Gender (scroll for selection)

Emergency Contact Person *

Emergency Phone * (xxx-xxx-xxxx)

Ministry Information

Your Ministry/Community Affiliation * (scroll and select one)

If student, scroll and select one *

If adult, scroll and select one *

Event Information

Scroll and select one *

Rooming (check all that apply) *

I will need a room on the following event nights:

All event nightsNo event nightsOne extra night-early arrival (check in advance with DLSI for availability)One extra night-late departure (check in advance with DLSI for availability)

Meals (scroll and select one) *

Meals I will not need (i.e. Last day box lunch) (If none, enter "NA") *

Special dietary needs (If none, enter "NA") *

Flight Information

Air arrival (date/airline/flight number/time)

Air departure (date/airline/flight number/time)

Needs/Permissions

Any other special needs or information (If none, enter “NA”) *

Events Photography/Video Policy (Check box to acknowledge.):

By attending this event and its activities, participants understand that their image may be captured by District of San Francisco New Orleans and may be used without compensation in photographs, videotapes, motion pictures or any other recordings or other record of this event that contains that image for any purpose, including for future advertising for the event.


Additional Information

For June 18-20 District Chief Administrators Association Meeting Attendees ONLY:

I am willing to stay in a nearby hotel if no room is available at Mont La Salle:

YesNo


Verify & Submit Registration