Steubenville EAST Registration Part 1 2023

Steubenville EAST Registration Part 1

Steubenville Deposit Registration Form
Registration for the Steubenville EAST Youth Conference will take place in two parts:

Part 1: Securing Your Spot & Deposit – To initially reserve your spot you must complete the THIS FORM in its entirety.

Along with completing this form, a $50, nonrefundable, deposit is due within two weeks of submitting this form. If a deposit is not received within two weeks of completing the “Steubenville Deposit Registration Form” your spot will no longer be saved.

Part 2: Once both the “Steubenville Deposit Registration Form” and the $50 deposit are received by St. Pius X, you will receive email instructions for completing the second part of the registration. Once this waiver is completed your registration is complete!

To learn more about the 2023 St. Pius X trip to the Steubenville EAST Youth Conference, click on the link below to download the complete information packet.
Teen Participant Information

Please complete all required sections
Teen Name*

First NameLast Name
Teen Email*
example@example.com
Teen Phone Number*
Will only be used to contact for Steubenville or in case of emergencies
Parent/Guardian Information

Please complete all required sections
Parent/Guardian Name #1*

First NameLast Name
Parent/Guardian #1 Email*
example@example.com
Parent/Guardian #1 Phone Number*
Please enter a valid phone number.
Parent/Guardian Name #2

First NameLast Name
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 Phone Number
Please enter a valid phone number.
Miscellaneous Information

Please complete all required fields
Please choose the t-shirt size of the teen attending the Steubenville Youth Conference*
Please list the name of 1-2 other teens that you would like to be in a small group with:
St. Pius X will be covering breakfast on Friday morning, if you have any dietary restrictions please list them below:
A full list of meals that are covered in the trip vs. need to be covered by the teens themselves, are listed in the Steubenville EAST information packet.
Payment
A $50 non-refundable deposit is due within two weeks of completing this form to secure your teen's spot at the 2023 Steubenville EAST Youth Conference!

You can pay the deposit in this form below, or make a full payment if you choose.

You can also choose to pay by cash or check, made payable to "St. Pius X Chruch". If you choose this option, payment can be dropped off to Josh Kay at the parish office during normal business hours Mon.-Fri. or mailed with the following address:

St. Pius X Catholic Church

C/O: Josh Kay

23 Crumitie Rd.

Loundoville, NY 12211

Final payment is due no later than Sunday, July 17, 2023.

Online Payment

Pay Deposit Only

$50.00

Pay Full Registration Amount

$275.00

Total

$0.00

Credit Card

Should be Empty:

Steubenville EAST Registration Part 1

Teen Participant Information

Parent/Guardian Information

Miscellaneous Information

Payment

Credit Card