PAYC 2023 Registration

PENNSYLVANIA YOUTH CONVENTION 2023 REGISTRATION FORM

Note: 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? *

Individual
Group

*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? *

How many people will you be registering? *

Individual Registration

Name *

First

Last

Phone *

Age *

Youth Ages 12-17 & Hyphen Ages 18+

Email *

Chaperone Registration

Chaperone Name *

First

Last

Phone *

Age *

Must be 18+ years old to register as a chaperone

Email *

Layout

Which class will you be registering for? *

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will you be attending the Friday night Afterburner? *

ADD UP TO 20 REGISTRANTS BELOW

Person #1

Name #1 *

First

Last

Which class will this person be registering for? #1 *

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #1 *

Person #2

Name #2 *

First

Last

Which class will this person be registering for? #2 *

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #2 *

Person #3

Name #3

First

Last

Which class will this person be registering for? #3

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #3 *

Person #4

Name #4

First

Last

Which class will this person be registering for? #4

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #4 *

Person #5

Name #5

First

Last

Which class will this person be registering for? #5

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #5 *

Person #6

Name #6

First

Last

Which class will this person be registering for? #6

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #6 *

Person #7

Name #7

First

Last

Which class will this person be registering for? #7

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #7 *

Person #8

Name #8

First

Last

Which class will this person be registering for? #8

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #8 *

Person #9

Name #9

First

Last

Which class will this person be registering for? #9

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #9 *

Person #10

Name #10

First

Last

Which class will this person be registering for? #10

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #10 *

Person #11

Name #11

First

Last

Which class will this person be registering for? #11

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #11 *

Person #12

Name #12

First

Last

Which class will this person be registering for? #12

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #12 *

Person #13

Name #13

First

Last

Which class will this person be registering for? #13

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #13 *

Person #14

Name #14

First

Last

Which class will this person be registering for? #14

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #14 *

Person #15

Name #15

First

Last

Which class will this person be registering for? #15

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #15 *

Person #16

Name #16

First

Last

Which class will this person be registering for? #16

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #16 *

Person #17

Name #17

First

Last

Which class will this person be registering for? #17

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #17 *

Person #18

Name #18

First

Last

Which class will this person be registering for? #18

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #18 *

Person #19

Name #19

First

Last

Which class will this person be registering for? #19

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #19 *

Person #20

Name #20

First

Last

Which class will this person be registering for? #20

Youth (Ages 12-17)
Hyphen (Ages 18+)

Will this person attending the Friday night Afterburner? #20 *

LEADERSHIP INFORMATION

Layout

Pastor's Name *

First

Last

Church Name *

Layout

Youth Leader's Email *

Youth Leader's Phone *

PAYMENT INFORMATION

Total *

$ 0.00

Individual Registration *

Price: $ 100.00

Chaperone Registration *

Price: $ 70.00

Credit Card *

Card

Name on Card