Event Registration Form

* THESE FIELDS ARE REQUIRED.

1. Contact 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 and select one.) *

Zip *

Gender (Scroll and select one.)

Emergency Contact Person *

Emergency Phone * (xxx-xxx-xxxx)

2. Ministry Information

Your Ministry/Community Affiliation (Scroll and select one.) *

If you are a student, scroll and select one. *

If you are an adult, scroll and select one. *

3. Event Information

Scroll and select one. *

4. Rooming

I will need a room on the following event nights. (Check one.) *

All event nightsNo event nightsAll event nights except first nightAll event nights except last night

5. Meals

Scroll and select one. *

Meals I will not need (i.e. last day box lunch) (If none, enter n/a.) *

Special dietary needs (If none, enter n/a.) *

6. Flight Information (if applicable)

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

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

7. Needs/Permissions

Any other special needs or information (If none, enter n/a.) *

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.