PAYC 2023 Registration Please enable JavaScript in your browser to complete this form.PENNSYLVANIA YOUTH CONVENTION 2023 REGISTRATION FORMNote: Licensed ministers are free to attend all services. However licensed ministers are required to purchase an afterburner ticket if planning on attending. Standalone Afterburner tickets may be purchased separately on the Afterburner ticket form.Are you registering as an individual or for a group? *IndividualGroup*Groups of up to 20 can be registered together as long as the same payment is being utilized for the entire group and all members attend the same church and have the same pastor.*Are you registering as a chaperone? *YesNoHow many people will you be registering? *2 - $ 200.003 - $ 300.004 - $ 400.005 - $ 500.006 - $ 600.007 - $ 700.008 - $ 800.009 - $ 900.0010 - $ 1,000.0011 - $ 1,100.0012 - $ 1,200.0013 - $ 1,300.0014 - $ 1,400.0015 - $ 1,500.0016 - $ 1,600.0017 - $ 1,700.0018 - $ 1,800.0019 - $ 1,900.0020 - $ 2,000.00Individual RegistrationName *FirstLastPhone *Age *Youth Ages 12-17 & Hyphen Ages 18+Email *Chaperone RegistrationChaperone Name *FirstLastPhone *Age *Must be 18+ years old to register as a chaperoneEmail *LayoutWhich class will you be registering for? *Youth (Ages 12-17)Hyphen (Ages 18+)Will you be attending the Friday night Afterburner? *YesNoADD UP TO 20 REGISTRANTS BELOWPerson #1Name #1 *FirstLastWhich class will this person be registering for? #1 *Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #1 *YesNoPerson #2Name #2 *FirstLastWhich class will this person be registering for? #2 *Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #2 *YesNoPerson #3Name #3FirstLastWhich class will this person be registering for? #3Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #3 *YesNoPerson #4Name #4FirstLastWhich class will this person be registering for? #4Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #4 *YesNoPerson #5Name #5FirstLastWhich class will this person be registering for? #5Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #5 *YesNoPerson #6Name #6FirstLastWhich class will this person be registering for? #6Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #6 *YesNoPerson #7Name #7FirstLastWhich class will this person be registering for? #7Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #7 *YesNoPerson #8Name #8FirstLastWhich class will this person be registering for? #8Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #8 *YesNoPerson #9Name #9FirstLastWhich class will this person be registering for? #9Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #9 *YesNoPerson #10Name #10FirstLastWhich class will this person be registering for? #10Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #10 *YesNoPerson #11Name #11FirstLastWhich class will this person be registering for? #11Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #11 *YesNoPerson #12Name #12FirstLastWhich class will this person be registering for? #12Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #12 *YesNoPerson #13Name #13FirstLastWhich class will this person be registering for? #13Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #13 *YesNoPerson #14Name #14FirstLastWhich class will this person be registering for? #14Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #14 *YesNoPerson #15Name #15FirstLastWhich class will this person be registering for? #15Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #15 *YesNoPerson #16Name #16FirstLastWhich class will this person be registering for? #16Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #16 *YesNoPerson #17Name #17FirstLastWhich class will this person be registering for? #17Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #17 *YesNoPerson #18Name #18FirstLastWhich class will this person be registering for? #18Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #18 *YesNoPerson #19Name #19FirstLastWhich class will this person be registering for? #19Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #19 *YesNoPerson #20Name #20FirstLastWhich class will this person be registering for? #20Youth (Ages 12-17)Hyphen (Ages 18+)Will this person attending the Friday night Afterburner? #20 *YesNoLEADERSHIP INFORMATIONLayoutPastor's Name *FirstLastChurch Name *LayoutYouth Leader's Email *Youth Leader's Phone *PAYMENT INFORMATIONTotal *$ 0.00Individual Registration *Price: $ 100.00Chaperone Registration *Price: $ 70.00Credit Card *CardName on CardSubmit