Connected Young Adult Conference Registration
Connected Young Adult Conference
Registration
April 12 -13, 2024
Worship Night: First Baptist Church, Lubbock
Conference: Texas Tech BSM
Today
Are you affiliated with a church?
Yes
No
Church Information
To find your church, first enter the city where your church is located. Then find your church in the "Church Name" field. If you do not see your church in the list, click the "My church is not in the list" checkbox.
Church City
Church Name
My church is not in the list
Church Name
Church City
City ID
Church ID
Attendee Information
Select a track:
Leadership Track ($10)
Training church leaders to grow their young adult ministry or ignite a new one
Young Adult Track
Equipping young adults in their walk with Christ
Amount
Amount w discount
First Name
Last Name
Email
Cell Phone
Mailing Address
City
State
Zip code
What is your role at your church?
Do you have any food allergies?
Yes
No
Please list your food allergies
Payment Page
Staff validation
Discount Code
Discount Calculations
Discount percent
Group Discount calculated
Onsite Payment
Cash
Payment Type
Credit Card
eCheck
Registration Summary
Subtotal
$
Total Discounts Applied
$
Total before card fees
$
Credit Card Fees*
$
3% added for credit card processing
x
Total Amount Due
$
Credit Card Information
Name on Credit Card
Credit Card Number
Credit Card Type
Please select...
Visa
Mastercard
Amex
Discover
Credit Card Code
(Card Verification Value)
Expiration Month
Expiration Year
eCheck Information
Bank Name
Name of Account Holder
Bank Routing Number
Bank Account Number
Account Type
Checking
Savings
Business Checking
Customer Billing Information
First Name
Last Name
Email
Street Address
City
State
Please select...
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
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ME
MD
MA
MI
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MS
MO
MT
NE
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NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
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SC
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TN
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UT
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WA
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WY
Postal Code
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