Personal Info
First Name
Last Name
Marital Status
Single
Married
Spouse
Check here if your spouse will be attending the conference
Spouse's First Name
Spouse's Last Name
Spouse's E-mail
(please use your primary e-mail address to receive all Young Adult Retreat info)
Confirm Spouse's E-mail
* Birthdate
(mm/dd/yyyy)
We would prefer to room with single young adults from our Corps.
Yes
Address
City
State
<select state here>
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Outside United States
Zip Code
Phone
Division
<select division>
Adult Rehabilitation Centers Command
College for Officer Training
Eastern Michigan Division
Heartland Division
Indiana Division
Kansas and Western Missouri Division
Metropolitan Division
Midland Division
Northern Division
Other
NHQ
Territorial Headquarters
Test Division
Western Michigan/Northern Indiana Division
Western Division
Wisconsin and Upper Michigan Division
Corps
<select corps>
E-mail address
(please use your primary e-mail address to receive all Young Adult Retreat info)
Confirm E-mail address
* Birthdate
(mm/dd/yyyy)
Gender
Female
Male
Dietary Restrictions
Emergency Contact
Name
Phone
Workshops
Select Workshop
"Prophetic Witness" with Courtney Rose
"Prophetic Prayer" with Katie and Mitch Luse
"Making the Army Relevant in 2019: A Conversation" with Melissa Bledsoe
Registration Fees
Registration and meals
$0
# of Children (Only children age 0-5 allowed):
0
1
2
3
4
5
6
7
8
9
10
($10.00 per child)
$0
#1 First Name:
Last Name:
DOB:
(mm/dd/yyyy)
Other:
#2 First Name:
Last Name:
DOB:
(mm/dd/yyyy)
Other:
#3 First Name:
Last Name:
DOB:
(mm/dd/yyyy)
Other:
#4 First Name:
Last Name:
DOB:
(mm/dd/yyyy)
Other:
#5 First Name:
Last Name:
DOB:
(mm/dd/yyyy)
Other:
#6 First Name:
Last Name:
DOB:
(mm/dd/yyyy)
Other:
#7 First Name:
Last Name:
DOB:
(mm/dd/yyyy)
Other:
#8 First Name:
Last Name:
DOB:
(mm/dd/yyyy)
Other:
#9 First Name:
Last Name:
DOB:
(mm/dd/yyyy)
Other:
#10 First Name:
Last Name:
DOB:
(mm/dd/yyyy)
Other:
Total amount due
$0
Agreements
You must check all of the following boxes to indicate your agreement with these statements before submitting your registration.
I Agree
By checking this box I personally assume responsibility for my actions, and release The Salvation Army from loss, injury or damage to myself or my property provided that nothing contained herein shall excuse The Salvation Army from responsibility to act with reasonable care for the health and safety of myself or my property.
I Agree
By checking this box I hereby give The Salvation Army permission to use photos of me involved in Young Adult Retreat activities in their publications, promotions or other ministry materials.
If you choose not to check this box please call
Nate Irvine at 773-205-3686
to register.
I Agree
By checking this box I hereby give permission to the medical personnel selected by the conference director to order x-rays, routine tests, treatment; to release any records necessary for insurance purposes, and to provide or arrange necessary related transportation for me. Should any dispute or controversy arise, I agree to seek resolution according to Biblical principles.
Completing your registration
Check that all of the information entered above is correct and then click the "Submit Registration" button below to process your registration.
*You must be between the ages of 18-29
(by 10/25/2019)
OR active in young adult ministry on the local Corps or Divisional level to attend.