R.E.D Conference Registration Form

Online Event Registration Form

Please complete the following online form to secure your event registration.

Event:	Email:
First Name:*	Last Name:*
Phone #1: (###) ###-####	Phone #2: (###) ###-####
Street Address:*
City:*	State:*	Zip Code:*

Birthdate: mm/dd/yyyy*	Church:*
Gender:* MaleFemale
Names of Mentors: STUDENT LEADERS: To help R.E.D Conference Staff better encourage your gifts and contribution in ministry, please provide the names of three adults that you feel are mentors in your life at this time.
Mentor #1 First Name:	Mentor #1 Last Name:*
Mentor #1 Phone: (###) ###-####	Mentor #1 Email:*
Mentor #2 First Name:	Mentor #2 Last Name:*
Mentor #2 Phone: (###) ###-####*	Mentor #2 email:*






Event Registration Fee:* $60.00- Includes Event Registration Fee, Food and Overnight Accomodations

I understand payment of the indicated registration fee must be sumitted at the time of check in (cash or check).* Yes

I understand that if I choose to cancel my registration, I will do so at least two weeks prior to the event or pay a $35.00 cancellation fee.* Yes
Special Notes:
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