Adventurer Club Membership Registration Form

ADVENTURER CLUB REGISTRATION

Complete the form below to register your church's Adventurer Club. Registration due date is JANUARY 31ST 2026. You are now in Late Registration.
Club Name
Other Club Name
IF YOUR CLUB NAME IS NOT LISTED, PLEASE ADD IT HERE SO WE CAN UPDATE OUR DATABASE.
Church Name
Area
Registration Year
Director's Name

First NameLast Name
YESNO
Church Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Director's E-mail
Director's Phone Number

Area CodePhone Number
Number of Members
NUMBER OF MEN
NUMBER OF BOYS
NUMBER OF WOMEN
NUMBER OF GIRLS
TOTAL STAFF
TOTAL CHILDREN
Additional Personnel
Personnel #1

First NameLast Name
Email (Personnel #1)
example@example.com
Phone Number (Personnel #1)
Please enter a valid phone number.Format: (000) 000-0000.
YESNO
I will mail a check for the amount of $90 to the AYM office, made payable to the “Northeastern Conference Youth Ministries” and note “Adventurer Club Registration” in the memo. (Kindly write your church name as well if you are using a personal check.) Mail to: Northeastern Conference Youth Ministries, 115-50 Merrick Blvd., Jamaica, NY 11434.
I will be paying by credit/debit card. (Additional charges may apply)

My Products*

Late Adventurer Club Registration Fee (MAKE SURE YOUR TOTAL IS NOT $0.00 - Select box to add to cart)

Annual Club Fee ($65)

$90.00

Total

$0.00

ADVENTURER CLUB REGISTRATION