Summit Registration 2021

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Date

Youth Summit January 4, 2021

KidMin Summit January 25, 2021 New date due to impending forecast: February 22, 2021

Time

10am - 5pm

Address

FIRST ASSEMBLY

800 EAST VERNON AVENUE,
NORMAL, IL, 61761
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Which Summit will you be attending?* This field is required.KidMin Summit NEW DATE of 2/22/21 due to impending weather on original date of 1/25/21
KidMin Summit (2/22/2021)
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Full Name* This field is required.
First Name
Last Name
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I am the Main Youth or Children's Pastor* This field is required.Please be advised, The Summit is solely for the main Youth and Children's pastors of IL.
YESNO
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Church Name and City* This field is required.Please indicate which church you are currently serving at.
i.e. Cornerstone Church, - Bethalto, IL
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My spouse will be attending* This field is required.
Yes
No
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Spouse Name
First Name
Last Name
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E-mail* This field is required.
example@example.com
Confirm Email
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Phone Number* This field is required.
Area Code
Phone Number
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Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
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The Bahamas
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Botswana
Brazil
Brunei
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Burundi
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Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
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Colombia
Comoros
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Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
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Denmark
Djibouti
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Dominican Republic
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Egypt
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Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
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Guadeloupe
Guam
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Guinea
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Hungary
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Indonesia
Iran
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Israel
Italy
Jamaica
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Kenya
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Madagascar
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Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
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Senegal
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eSwatini
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Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Dietary RestrictionsPlease let us know if you have any food allergies or restrictions we should be aware of.
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Shirt Size
Small
Medium
Large
XL
2XL
3XL
4XL
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Spouse Shirt Size
Small
Medium
Large
XL
2XL
3XL
4XL
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Upload a photo of yourself* This field is required.For Lanyard ID. Please be sure it is a recognizable photo
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Upload a photo of your spouse (if attending)For Lanyard ID. Please be sure it is a recognizable photo
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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