"Celebrating Our Soul" People of African Descent New Thought Conference Youth Registration Form

Name

Parent/Guardian

Date of Birth

Address

This address will receive a confirmation email

Phone

Emergency Contact:

Name

Choose What Best Describes your Child's Gender

Male Female Other

If other, please input preference:

Mobile Phone

Meal Preference:

Enter food preference if not listed:

T-Shirt Size, you can select youth or adult size for your child

Tee-Shirt size

Youth Small Youth Medium Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL Other

Enter Tee-shirt size, if other:

Medical/Liability/ Photo Release

Photography Release: I hereby grant the Celebrating Our Soul, People of African Descent New Thought Conference, its designees and its representatives permission to use, without compensation or restriction, photographic and videotaped images from Celebrating Our Soul events in which the participant appears, in any manner whatsoever such as, but not limited to: publication, advertising, slide shows, web site, etc.

Confidentiality Release: I understand that health information on this form will only be shared, as needed, with group leaders, staff and medical professionals to safeguard and support the participant. This information will not be publicly disseminated or released to any outside organization.

List medical information: if none please enter none.

Registration Fee:

Student $75.00 Scholarship =$0.00 Virtual $50.00 Virtual - Scholarship $0.00

If using USA or Canadian Credit or debit Card, input card information below and submit.

If using an International Credit or Debit card, Please use link to make payment only:
Youth International Registration payment
in the payment dropdown- select internation Credit or Debit.

The Breeze registration form must be completed also!

If you choose to use Checking account information, then go to:

Text-To-Give at (909)330-4808
Or
click this link: Online Giving Using Checking information

Remember to select link to make payment for international Credit or Debit cards.

If using an International Credit or Debit card, Please use link:
Youth International Registration payment
in the payment dropdown- select internation Credit or Debit

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

We invite you to register your Child/Student for “Celebrating Our Soul” New Thought Conference: A Conference by People of African Descent. This conference will be at Unity Village, Kansas City, MO, August 11-14, 2022.

The registration fee of $75.00 for youth ages 7-18. There are some scholarships available at this time.

We are so happy you have decided to join us and look forward to our journey to "Celebrating Our Soul".
We look forward to connecting with you at the event.
Note: Your confirmation might go into your junk or promotional email. Please check there first.

"Celebrating Our Soul" People of African Descent New Thought Conference Youth Registration Form

Description

Please Fix the Following