LIFE 2019 Registration Form
 
LIFE 2019 Registration Form
Youth 1 Name (As it appears on license or school ID)  * 
Youth 1 Grade (Students have to be entering 9th grade in the 2019/20 school year up to and including 2020 high school graduates.)  * 
Birth date  * 
Age  * 
Youth 2 Name (As it appears on license or school ID)
Youth 2 Grade
Birth date
Age
Youth 3 Name (As it appears on license or school ID)
Youth 3 Grade
Birth date
Age
Parent’s Names  * 
Address  * 
Emergency contact number  * 
City  * 
Your Email Address  * 
I give permission for my son/daughter to attend the LIFE2019 Conference in Orlando, FL on July 9 - 13. I understand that I am responsible for the full cost of the trip and that the $270 deposit is non-refundable.  * 
Registration for LIFE 2019  * 
If interested in participating in the Momentum 5K, the additional cost will be $35 which will include getting a t-shirt. Please select the t-shirt size. The additional cost of the t-shirt will be added to your account. The sizes are S, M, L, XL, 1X, 2X, 3X.
Total $
 
 
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