Last Name:

First Name: 

Nick Name:

Street Address:

City:

State:

Zip:

Church:

Presbytery:

Daytime Phone: 

Evening Telephone

Email Address:

Emergency Contact Name: 

Relationship and Telephone #:

Roommate Requested: 

Special Needs: 

Times attending Conference (Prior to this year):

Attending with my Dad/Son - Name

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Conference Packages:
(Review and make your selection below)

LS - $380 Deluxe Single  - (Single Occupancy)
Conference registration, 6 meals, room for 2 nights in the New Lodge(2 Queen beds, private bath)

LD - $320 Deluxe Double  - (Double Occupancy)
Conference registration, 6 meals, room for 2 nights in the New Lodge(2 Queen beds, private bath)

RS - $325 Regular Single  - (Single Occupancy)
Conference registration, 6 meals, room for 2 nights in Richardson Dorm(2 twin beds, shared bath with adjacent room)

RD - $275 Regular Double  - (Double Occupancy)
Conference registration, 6 meals, room for 2 nights in Richardson Dorm(2 twin beds, shared bath with adjacent room.

CM - $180 Day Attendance
Conference registration, 6 meals, No lodging.

CO - $95 Conference Only
Conference registration, No meals, no lodging.

Select your desired option below.

(Click the appropriate button)

Reduce your cost if any of the following apply

Each One Bring One: $50 off if you are a returning registrant who brings a new first-time conferee.
$50 off if you are a first-time registrant who is being sponsored by someone.

Early Bird Discount:  Register before June 1, 2013 and take $10 off your registration.

Select the appropriate options below by checking the box.

Select a special activities for Saturday afternoon if you desire
( If you do not wish to participate in an activity, please select the "No Activity" button)

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Please total cost of items checked.  
Type that cost in the box.
Make sure to click "Submit" when you complete the form