Youth & Young Adult Engagement Sumit

First name

Last name

Phone

What church do you attend?

District

How many are in your party?

Will you need hotel accomidations?

Conference Hotel: Holiday Inn Byram, MS. Registration prices are per person. Two guests are required for King Rooms, 3-4 guests are required for Room with Double Beds.

Registration Non Refundable

General Registration $25

Registration Plus Hotel: King Bed (2 Guest required at $40 per person)$40

Registration Plus Hotel: Double Beds (minimum 3 Guests at $40 per person)$40

Registration Plus Hotel: Double Beds (maximum 4 Guest at $40 per person)$40

Please provide the name(s) of all persons you are registering for. Please include yourself as guest 1. Then list all others. The names provide will be used for hotel room assignments, if applicable.

Guest 1

Guest 2

Guest 3

Guest 4

Please list any other persons you are registering for.

If your roommate (s)will register separately, please list name of desired roommate(s) here