Individual Registration Form
Please fill out this form and click submit.
Registrant Section
Name
*
Address
*
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MT
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PA
PE
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YT
Date of Birth
*
Gender
*
Please select one option.
Male
Female
Email
*
This address will receive a confirmation email
Phone
*
T-Shirt Size:
*
Please select one option.
Small
Medium
Large
XLarge
2XLarge
3XLarge
Select Option
Small
Medium
Large
XLarge
2XLarge
3XLarge
I intend to receive the Lord's Supper at the Divine Service.
*
Please select all that apply.
Yes
No
I have attended a Higher Things conference before.
*
Please select all that apply.
Yes
No
Indicate which age group the Registrant will be at the time of the conference.
*
Please select all that apply.
Infant (0-1)
Toddler (2-4)
Child (5-11)
Youth (12-17)
Young Adult (18-20)
Adult (21+)
Pastor
I have a disibality/medical conditions/dietary or special need:
*
Please select all that apply.
Yes
No
Please only include special needs that affect housing assignments and/or dietary requirements. Other special needs should be discussed with your Group Leader and chaperones.
*
Group Church Name
*
Church Phone
Church Address
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Group Leader's Name
Pastor's Name
Parent/Guardian Section (required for minor youth participants only)
Name
*
Phone
*
Address (if different from above)
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Parent's Email
*
This address will receive a confirmation email
I grant permission for my minor child, named above on this form as "Registrant," to attend the Higher Things youth conference. I assume all responsibility and liability for injury to said minor while at the Higher Things conference. I also give Higher Things, Inc. permission to use any still, audio, and/or video images of my child in conference publicity and news releases. (Parent's Signature and Date)
*
Submit
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