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Convention 2024 Church InformationI am registering as a:- Select -StudentSponsor (must be at least 21 years old)SpeakerPlease select your registration type Member Church ($430) Member Church Late ($480) Non-Member Church ($310) Non-Member Church Late ($580)Church Information- Select -Non-member ChurchBeaverdam CRC, Hudsonville, MIBellingham URC, Bellingham, WABethany URC, Wyoming, MI *Bethel CRC, Manhattan, MTBethel Reformed OPC, Fremont, MIBethel URC, Jenison, MI *Burlington URC, Burlington, WACalvary CRC, Orange City, IACalvary URC, Loveland, COCentral Ave. CRC, Holland, MIChrist Reformed, Nampa, IDChrist Reformed, Santee, CAChrist Reformed, Sioux Falls, SDCloverdale URC, Boise, IDCommunity URC, Schererville, INCornerstone Christian Church, Medford, ORCornerstone URC, Hudsonville, MI *Cornerstone URC, Sanborn, IACovenant Grace Reformed Church, Lynden, WACovenant Reformed, Kansas City, MOCovenant Reformed, Pella, IACovenant Reformed, Carbondale, PACovenant URC, Byron Center, MICovenant URC, Pantego, NCCovenant URC, Kalamazoo, MICovenant URC, Newton, NJDoon URC, Doon, IADutton URC, Dutton, MIEastmanville URC, Eastmanville, MI *Escondido URC, Escondido, CAFaith URC, Beecher, ILFaith URC, Holland, MIFirst CRC, Orange City, IAFirst CRC of Prinsburg, MNFirst URC, Oak Lawn, ILFirst URC of Chino, Chino, CAGrace Fellowship OPC, Zeeland, MIGrace Reformed, Lethbridge, ABGrace URC, Alto, MI *Grace URC, Milwaukie, ORGrace URC, Waupun, WIHills URC, Hills, MNHudson Valley URC, Middletown, NYImmanuel Covenant Reformed, Abbottsford, B.C.Immanuel Fellowship, Kalamazoo, MI *Immanuel URC, DeMotte, INImmanuel URC, Listowel, ONImmanuel’s Reformed (URC), Salem, ORLittle Farms OPC, Coopersville, MILynden URC, Lynden, WALynwood URC, Lynwood, IL *Messiah’s IRC, Holland, MI *Messiah’s Reformed Fellowship, Brooklyn, NYNew Covenant URC, Twin Falls, IDNew Haven URC, New Haven, VTNorth Street CRC, Zeeland, MIOak Glen URC, Lansing, IL *Ontario URC, Ontario, CAPhoenix URC, Phoenix, AZPompton Plains Reformed Bible Church, NJ *Preakness Valley URC, Wayne, NJProvidence Reformed Church, Des Moines, IAProvidence Reformed Church, Winnipeg, MBProvidence URC, Strathroy, ONRedeemer OPC, Ada, MIRedeemer Presbyterian Church (PCA), Holland, MIRedeemer Reformed (RCUS), Crystal, MNRedeemer URC, Orange City, IARedeemer URC, St. John, INRock Valley URC, Rock Valley, IARockford Springs Community OPC, Rockford, MISecond CRC of Kalamazoo, MISeventh Reformed, Grand Rapids, MI *Sioux Center URC, Sioux Center, IAThe Well Church, Boise, IDTrinity CRC, Sparta, MITrinity Reformed Church, Cape Coral, FLTrinity Reformed Church (URC), Lethbridge, ABTrinity URC, Visalia, CATrinity URC, Caledonia, MI *URC of Thunder Bay, Thunder Bay, ONWalker URC, Grand Rapids, MIWest Sayville URC, West Sayville, NYWorthington CRC, Worthington, MNZeltenreich Reformed, New Holland, PAZion URC, Ripon, CAYour ChurchPreviousNextPersonal InformationTitle- Select -MissMrsMrRevDrFirst NameMiddle Name / InitialLast NameEmailBirth DatePreviousNextAge/Grade InformationAge As Of July 17, 2023- Select -141516171821 or older - sponsors must be at least 21 years oldGrade Completed As Of July 17, 2023- Select -9101112Gender- Select -FemaleMaleYou're a speaker, there's no need to fill any of this out. Please click "Next".PreviousNextConvention WorkshopsPlease select six preferences for workshops to attendWorkshop #1Workshop #2Workshop #3Workshop #4Workshop #5Workshop #6Workshop #7Workshop #8Workshop #9Workshop #10You're a speaker, there's no need to fill any of this out. Please click "Next".PreviousNextDay AwayDay Away Location 1 Location 2PreviousNextRYS StoreRYS T-Shirt: Everyone receives a t-shirt, please select your size- Select -SMLXLXXLXXXLPreviousNextRoommate InfoChoose one roommate or go potluck. Roommate must also list you on their registration form.- Select -PotluckSpecific person/people (you will be asked below)Name (first and last) and the church of your preferred roommate. Roommate must also list you on their registration form.PreviousNextEmergency Contact Information 1Emergency Contact First NameEmergency Contact Last NameEmergency Contact EmailEmergency Contact PhoneEmergency Contact Alt. Phone (optional)Emergency Contact AddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweEmergency Contact's Relationship to RegistrantPreviousNextEmergency InformationWhat should we know about the registrant if there's an emergency?Please list any special needs we may need to know about (eg. wheelchair access, etc.)Does the registrant have / had allergies? Yes NoPlease explain your allergiesDoes the registrant have / had medical conditions? Yes NoPlease explain your medical condition(s)Does the registrant have / had any physical restrictions? Yes NoPlease explain your physical restrictionsIs the registrant currently taking any medications? Yes NoPlease explainCurrent Medications and Dosage(s)Has the registrant ever had a concussion? Yes NoPlease tell us when and how many concussions. NOTE: If a conventioneer has had a concussion less than 3 months prior to Convention, they may not participate in our organized sports. We ask that you discuss any medical conditions or any important medications with the attending convention sponsor. This is for the protection of your own child and /or in case of an emergency. The size of our convention has become too large for us to monitor all of the medical forms.Name(s) of sponsors to whom the registrant may be releasedI certify that the information on this form is true to the best of my knowledge. I understand that every effort will be made to contact me, but I do hereby give my permission for the Convention staff or any licensed physician to render emergency medical care in the event of a medical emergency. I hereby release Reformed Youth Services, its employees, volunteers, and other youth leaders from any liability for any claims of damages or injury to myself. I understand that by signing this agreement, I absolve Reformed Youth Services, its employees, volunteers and other youth leaders for any liability for any claims of damages or injury to myself and my property for any injury or damages that may occur, including serious injury or death. I also agree not to sue Reformed Youth Services, its employees, volunteers and other youth leaders for any liability for any claims of damages or injury to myself or my property. I have read this release and agreement not to sue. I understand it and I am bound by its provisions. *REGISTRANTS MUST ACKNOWLEDGE THE RISK OF THE COVID-19 VIRUS, IF ANY, AT THE TIME OF THE CONFERENCE. AS MUCH AS POSSIBLE, RYS WILL MAINTAIN SUGGESTED SOCIAL DISTANCING AND SANITIZING PRECAUTIONARY PROCEDURES. REGISTRANTS MUST RELEASE RYS FROM ANY LIABILITY RELATED TO COVID-19.* Please type your name.*Today's DatePreviousNextInsurance InformationI do not have insurance at this time I do not have insurance at this timeInsurance CompanyInsurance Policy NumberInsurance Group NumberPreviousNextView and SignPut in copy here I have read and agree to the Rules AcknowledgementPut in copy here I have read and agree to the Dress CodePaymentNo payment items has been selected yet Previous Continue to Payment
