Personal Info


First Name
Last name
Staff?
Spouse
Spouse's First Name
Spouse's Last Name
Staff?
Spouse's E-mail
(please use your primary e-mail address to receive all Regeneration info)
Confirm Spouse's E-mail
* Birthdate
Young Adult Leader?

How are you active in Young Adult Ministry?

Dietary Restrictions





Other:

Salvationist's First Name
Salvationist's Last Name
Mailing Address
City
State
Zip Code
Phone
Division
Corps
E-mail address
(please use your primary e-mail address to receive all Regeneration info)
Confirm E-mail address
* Birthdate
Young Adult Leader?

How are you active in Young Adult Ministry?

Gender
Dietary Restrictions





Other Restrictions
Emergency Contact
Name
Relationship
Phone
Comments


Registration Fees


Registration and meals
$0
# of Children (Only children age 0-5 allowed):  
($20.00 per child)

$0
#1 First Name:
Last Name:
DOB:
Diet Restrictions

Other:

#2 First Name:
Last Name:
DOB:
Diet Restrictions

Other:

#3 First Name:
Last Name:
DOB:
Diet Restrictions

Other:

#4 First Name:
Last Name:
DOB:
Diet Restrictions

Other:

#5 First Name:
Last Name:
DOB:
Diet Restrictions

Other:

#6 First Name:
Last Name:
DOB:
Diet Restrictions

Other:

#7 First Name:
Last Name:
DOB:
Diet Restrictions

Other:

#8 First Name:
Last Name:
DOB:
Diet Restrictions

Other:

#9 First Name:
Last Name:
DOB:
Diet Restrictions

Other:

#10 First Name:
Last Name:
DOB:
Diet Restrictions

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.

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 Regeneration activities in their publications, promotions or other ministry materials.
If you choose not to check this box please call on to register.
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 2/15/2018) OR active in young adult ministry on the local Corps or Divisional level to attend. (If you are 30 or over will need to describe your involvement on the registration form and have approval from your Divisional Youth Secretary).