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Registration



Name
Title
First Name
Last Name
Spouse Information
Spouse Name

Title
First Name
Last Name
Gender

DOB
(mm/dd/yyyy)		T-Shirt Size
Position
Requested Roommate
Dietary Restrictions






Other

Email


If you are attending Regeneration, please click the checkbox so that we can use the information to assign housing for both events at once. PLEASE NOTE: Clicking this checkbox does NOT register you for Regeneration. It only helps us with assigning housing. You MUST go to the Regeneration website to register separately for that conference.

Position
Address
City
State
Zip
Phone
E-mail
Gender
Date of Birth
 (mm/dd/yyyy)
T-Shirt Size
Requested
Roommate
Dietary Restrictions





Other:


Division
Corps

Emergency
contact
Name:
Phone:

Electives

Please select your Challenge Activity. Activity space will be available on a first come, first serve basis (only activities that are still open are listed)
Please select your Discover Activity. Activity space will be available on a first come, first serve basis (only activities that are still open are listed)
Challenge Activity DescriptionsDiscover Activity Descriptions

Registration Fee


Registration Fee:$0
Discount:-$0
Registration Total:$0

Agreements

You must check all of the following boxes to indicate your agreement with these statements before submitting your registration.

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.
By checking this box I hereby give The Salvation Army permission to use photos of me involved in Refuel activities in their publications, promotions or other ministry materials.
If you choose not to check this box, complete your registration and then email a photo of yourself, spouse and/or children to USC.Youth@usc.salvationarmy.org as soon as possible.
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.