EmailMe Form - APPOINTED: FOR THE CHURCH AND THE WORLD

CHURCH INFORMATION

Please fill out the following information. If the following information does not pertain to you, please input N/A.

Church's Name *

Lead Pastor's Name *

First Last

Lead Youth Pastor/Leader's Name *

First Last

Youth Pastor/Leader's Primary Phone *

### - ### - ####

Youth Pastor/Leader's Primary Email

REGISTRATION COUNT

Please note that priority deadline for pre-registration is March 25th, 2019.

Total Number of Males *

*Including leader if applicable

Total Number of Females *

*Including leader if applicable

Names of Males (First, Last) *

Names of Females (First, Last) *

Overall Total Payment *

$ Dollars . Cents

OVERNIGHT STAY PRICING
Priority Registration $25.00/person
Regular Registration $35.00/person

Example: Payment for priority registration completed before the 25th of March with 5 males and 7 females:
12 total people x $25.00/person = $300.00

DEBIT/CREDIT CARD INFORMATION

Please note that a 3% fee will be added to all debit/credit card transactions. Also, please allow 1-3 business days for your debit/card to be processed. You will receive a confirmation email once payment is successfully received.

Furthermore, please note that if payments intended for priority registration are not received by priority deadline, they will be considered as regular registration.

Card Holder's Name *

First Last

Card Holder Primary's Number *

### - ### - ####

Card Holder Primary's Email *

Debit/Credit Card Number *

Expiration Date *

MM / YY

V-Code *

3-digit code provided on the back of your card

Authorized Amount to Be Charged *

$ Dollars . Cents

Electronic Signature of Card Holder *

By signing this, the card holder agrees to have their debit/credit card charged by LABI College for the authorized amount provided above.

ADDITIONAL REQUIRED DOCUMENTS BEFORE SUBMISSION

Before completing your online registration for College Days 2019, please be informed that each individual in your group is still required to submit an Individual Registration Form. Furthermore, each vehicle owner using their vehicle for this event is also required to submit a Vehicle Registration Form.

You can find both these forms available for download on the College Days website page in STEP 2 under Online Registration. Once you've located these forms, please have them filled out and ready to give on-site on the day of the event.

Please Sign for Agreement *