Back At It Challenge Registration

Full Name*

First NameLast Name
Age*
Phone Number*
Format: (000) 000-0000.
Email
example@example.com
What church do you attend?*
Your Pastor's Name*
Select your District
Shirt size*

Youth XSmall (size 2-4)Youth Small (size 6-8)Youth Medium (size 10-12)Youth Large (size 14-16)Youth XL (size 18-20)Adult SmallAdult MediumAdult LargeAdult x largeAdult 2xAdult 3xAdult 4xAdult 5x
PAYMENT REQUIRED IMMEDIATELY OR REGISTRATION WILL NOT BE ACCEPTED!
Early-Bird Special!! Dec 26th - Jan 26th $30.00 Payment Method*

$5thILWestYPWW (CASH APP)Godsplan@live.com (ZELLE)
Jan. 27th - Feb. 27th $35.00 Payment Method*

CashCheck$5thILWestYPWW (CASH APP)Godsplan@live.com (ZELLE)
Feb 28th - April 24th $40.00 Payment Method*

CashCheck$5thILWestYPWW (CASH APP)Godsplan@live.com (ZELLE)
Due to t-shirt order deadline we can no longer accept t-shirt orders and your registration is now $15 which includes workshop sessions, materials, bags and your lunch buffet ticket.
Type a question
Before Submitting Please ensure your payment is made to lock in your early registration rate. Please note that registrations are only considered valid once payment has been received. Thank you for your cooperation & we will see you in Davenport!
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PAYMENT REQUIRED IMMEDIATELY OR REGISTRATION WILL NOT BE ACCEPTED!