Youth Leader Development & Networking Retreat Registration
May 9 - 11, 2024
Name
*
First Name
Last Name
Gender
*
Male
Female
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Church
*
What is your youth staff role?
*
Pastor, intern, volunteer, small group leader, etc.
Special Housing Requests
Food Allergies/Dietary Restrictions
Will you be paying for more than one person?
Yes
No
List the names of the staff members you are paying.
Please make sure each staff member fills out their own registration form even if they are being paid for by another person.
Dunes Youth Leader Retreat Payment Options
*
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next
( X )
Dunes YLR - Pay Now
Includes program, lodging, and meals.
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Dunes YLR - Pay Later
My church/organization will be paying at a later date.
$
Free
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: