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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( X )
Dunes YLR - Pay Now
Includes program, lodging, and meals.
$10.00
$
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
$
Free
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit
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