Teen Rally & Junior Roundup Church Registration Form

Teen Rally & Junior Roundup Church Registration Form
Which Event Are You Attending?*
Church Information
Church Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Phone*

Area CodePhone Number
Contact E-mail*
Senior Pastor Name

First NameLast Name
Senior Pastor Email
example@example.com
Youth Pastor or Adult Sponsor Name

First NameLast Name
Youth Pastor or Adult Sponsor Email
example@example.com
Youth Pastor or Adult Sponsor Phone

Area CodePhone Number
Number of Youth Planning to Attend*
Number of Adult Sponsors Planning to Attend
Payment Information
PayPal Payment
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Church Registration Fee $10.00
(This may be applied towards the sponsor's registration fee at check-in)

Total $0.00
Other Payment Options

Choose option below if not paying online.Mailing Check ($10.00 Per Church)Call our office (585.689.4520) with a credit card (MasterCard, Visa, Discover).
Any questions or comments about your registration:
Junior Roundup Waiver Teen Rally Waiver
Pay with PayPal

Please click one of the PayPal options to complete payment and submit the form.
Should be Empty:

Payment Information