SWYC 2018 1 Night/3 Meals Registration HiddenSWYC* SWYC 2018: Abiding In Christ HiddenRegistration Mode (Admin-Only) Early Bird Regular Late Please pick Registration and Lodging Type. 1 Night/3 Meals Lodge Registration Maximum people per lodge is 6. Any number over 6 will be staying in another lodge.1 Night/3 Meals Cabin Registration Maximum people per lodge is 10. Any number over 10 will be staying in another lodge.1 Night/3 Meals RV Registration1 Night/3 Meals Tent RegistrationEARLY REGISTRATION: MARCH 18-APRIL 29REGULAR REGISTRATION: APRIL 30-JULY 1LATE REGISTRATION: JULY 2nd – AUGUST 29thRegistration Type* Single Group HiddenDuration*1 Night/3 MealsLodging Type*LodgeCabinRVTentCabin Type*Please choose your cabin respectively to your gender. Male Female Cabin Type*Check that applies. Check both if you are registering both males and females. Male Cabin Female Cabin Name* First Last Age*Please enter a number from 0 to 130.Group Name (Optional) Guardian's/Parent's Name* Mr.Mrs.MissMs.PastorDr.Prof.Rev.Engr. Prefix First Last Age*Please enter a number from 18 to 130.Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact Phone*Contact Email* Are you the Tent Owner? ($15 Tent Registration Fee)* Yes No Are you the Tent Owner? ($15 Single Tent Registration Fee)* Yes No How many tents are you trying to register? Quantity*Tent Registration is $15/Tent Price: $15.00 Quantity Are you the Tent Owner? ($10 Tent Registration Fee)* Yes No Are you the Tent Owner? ($10 Single Tent Registration Fee)* Yes No How many tents are you trying to register? Quantity*Tent Registration is $10/Tent Price: $10.00 Quantity Are you the Tent Owner? ($5 Tent Registration Fee)* Yes No Are you the Tent Owner? ($5 Single Tent Registration Fee)* Yes No How many tents are you trying to register? Quantity*Tent Registration is $5/Tent Price: $5.00 Quantity Tent Owner's Info*Tent owners must pay a “Tent Registration Fee”.FirstLastEmailAre you the RV Owner? ($60 Single RV Registration Fee)* Yes No Are you the RV Owner? ($60 RV Registration Fee)* Yes No Are you the RV Owner? ($40 Single RV Registration Fee)* Yes No Are you the RV Owner? ($40 RV Registration Fee)* Yes No Are you the RV Owner? ($20 Single RV Registration Fee)* Yes No Are you the RV Owner? ($20 RV Registration Fee)* Yes No RV Owner's Info*RV owners must pay a “RV Registration Fee”.FirstLastEmailAdd Adult/Minor Registration (13 yrs old and up) Check Here If you are registering minors, parents/guardians need to complete minor consent form.* Okay I’m not registering any minors How many adults/minors staying in a 1 Night/3 Meals Lodge?*All adults must be aged 18+ years old.Please enter a number from 1 to 99.How many adults/minors staying in a 1 Night/3 Meals Cabin?*All adults must be aged 18+ years old.Please enter a number from 1 to 99.How many adults/minors staying in a 1 Night/3 Meals RV?*All adults must be aged 18+ years old.Please enter a number from 1 to 99.How many adults/minors staying in a 1 Night/3 Meals Tent?*All adults must be aged 18+ years old.Please enter a number from 1 to 99.1 Night/3 Meals Lodge* 2 Person Room – $108/Person (Family-Type, Spacious Room) 3 Person Room – $87/Person 4-6 Person Room – $75/Person (Recommended for a small group) 1 Night/3 Meals Cabin* Adult Registration – $60 1 Night/3 Meals RV* 1 Night/3 Meals – $55 1 Night/No Meals – $20 1 Night/3 Meals Tent* 1 Night/3 Meals – $55 1 Night/No Meals – $20 1 Night/3 Meals Lodge (Single Registration)* 2 Person Room – $108/Person (Family-Type, Spacious Room) 3 Person Room – $87/Person 4-6 Person Room – $75/Person (Recommended for a small group) 1 Night/3 Meals Cabin (Single Registration)* 1 Night/3 Meals – $60 1 Night/3 Meals RV (Single Registration)* 1 Night/3 Meals – $55 1 Night/No Meals – $20 1 Night/3 Meals Tent (Single Registration)* 1 Night/3 Meals – $55 1 Night/No Meals – $20 Name of the adult(s)/minor(s)* Use the “+” sign to add another name. TitleFirstLastAge Name of the adult(s)/minor(s) staying in MALE CABIN* Use the “+” sign to add another name. TitleFirstLastAge Name of the adult(s)/minor(s) staying in FEMALE CABIN* Use the “+” sign to add another name. TitleFirstLastAge Add Child Registration (4 to 12 yrs old) Check Here How many children are staying in 1 Night/ 3 Meals Lodge?*Please enter a number from 1 to 99.How many children are staying in 1 Night/ 3 Meals Cabin?*Please enter a number from 1 to 99.How many children are staying in 1 Night/ 3 Meals RV?*Please enter a number from 1 to 99.How many children are staying in 1 Night/ 3 Meals Tent?*Please enter a number from 1 to 99.1 Night/ 3 Meals Lodge (Child)* Child Registration – $65 1 Night/ 3 Meals Cabin (Child)* Child Registration – $50 1 Night/ 3 Meals RV (Child)* 1 Night/ 3 Meals – $40 1 Night/ No Meals – $10 1 Night/ 3 Meals Tent (Child)* 1 Night/ 3 Meals – $40 1 Night/ No Meals – $10 1 Night/ 3 Meals Lodge (Single Child Registration)* Child Registration – $65 1 Night/ 3 Meals Cabin (Single Child Registration)* Child Registration – $50 1 Night/ 3 Meals RV (Single Child Registration)* 1 Night/ 3 Meals – $40 1 Night/ No Meals – $10 1 Night/ 3 Meals Tent (Single Child Registration)* 1 Night/ 3 Meals – $40 1 Night/ No Meals – $10 Name of the child(ren)*Use the “+” sign to add another name. FirstLastAge Add Babies/Toddlers (0 to 3 yrs old are free of charge) Check Here How many babies/toddlers staying in 1 Night/ 3 Meals Lodge?*All children must be accompanied by a registered adult.Please enter a number from 1 to 99.How many babies/toddlers staying in 1 Night/ 3 Meals Cabin?*All children must be accompanied by a registered adult.Please enter a number from 1 to 99.How many babies/toddlers staying in 1 Night/ 3 Meals RV?*All children must be accompanied by a registered adult.Please enter a number from 1 to 99.How many babies/toddlers staying in 1 Night/ 3 Meals Tent?*All children must be accompanied by a registered adult.Please enter a number from 1 to 99.1 Night/ 3 Meals Lodge (Babies/Toddlers)* Babies/Toddlers – Free Registration 1 Night/ 3 Meals Cabin (Babies/Toddlers)* Babies/Toddlers – Free Registration 1 Night/ 3 Meals RV (Babies/Toddlers)* Babies/Toddlers – Free Registration 1 Night/ 3 Meals Tent (Babies/Toddlers)* Babies/Toddlers – Free Registration Single Registration (Babies/Toddlers)* Babies/Toddlers – Free Registration Name of the babies/toddlers?*Use the “+” sign to add another name. FirstLastAge Minor Consent Form*Medical ReleaseIn the event that my minor child requires medical attention during the conference and the chaperone cannot be located, GYC Southwest and its representatives are hereby authorized to select a medical treatment facility, physician, and any and all necessary medical care required in case of an accident or illness of my minor child. I understand that GYC Southwest will attempt to contact me in case of an emergency. In the event that I am unable to be reached in a timely manner, I will hold harmless and release from all liability GYC Southwest and its representatives for supervising, initiating or ordering any and all required emergency care for my minor child.In any event, I will be responsible for any and all payments of treatments, hospitalization, anesthesia, or surgery related to the emergency care of my minor child. Liability Release & Disclaimer GYC Southwest reserves the right to deny, cancel or alter the registration of any person who (A) fails to provide, true, accurate, current and complete information, or (b) violates any of GYC Southwest’s policies or procedures, including but not limited to, the registration and attendance by minors. GYC Southwest is not responsible for any loss or liability, financial or otherwise, that may result directly or indirectly from such denial, cancellation or alternation of any person’s registration. All attendees participate in conference seminars and conference events at his or her own risk. Neither GYC Southwest, it’s Directors, Officers nor Agents accept any liability of any kind whatsoever, regardless of the manner in which such liability may have arisen. At its sole discretion, GYC Southwest reserves the right to alter, postpone or cancel any conference seminar or conference events with or without notice. Parent/Legal Guardian Agreement* By selecting “I Agree” button below, I agree that I have read and understand the provisions of this consent form in their entirety. I am not relying on the advice or interpretation of another person, besides my legal counsel, and have signed this consent form of my own volition. To the best of my knowledge, all information provided in the registration is true and accurate. I Agree Minor Consent Form*Medical ReleaseIn the event that my minor child requires medical attention during the conference and the chaperone cannot be located, GYC Southwest and its representatives are hereby authorized to select a medical treatment facility, physician, and any and all necessary medical care required in case of an accident or illness of my minor child. I understand that GYC Southwest will attempt to contact me in case of an emergency. In the event that I am unable to be reached in a timely manner, I will hold harmless and release from all liability GYC Southwest and its representatives for supervising, initiating or ordering any and all required emergency care for my minor child.In any event, I will be responsible for any and all payments of treatments, hospitalization, anesthesia, or surgery related to the emergency care of my minor child. Liability Release & Disclaimer GYC Southwest reserves the right to deny, cancel or alter the registration of any person who (A) fails to provide, true, accurate, current and complete information, or (b) violates any of GYC Southwest’s policies or procedures, including but not limited to, the registration and attendance by minors. GYC Southwest is not responsible for any loss or liability, financial or otherwise, that may result directly or indirectly from such denial, cancellation or alternation of any person’s registration. All attendees participate in conference seminars and conference events at his or her own risk. Neither GYC Southwest, it’s Directors, Officers nor Agents accept any liability of any kind whatsoever, regardless of the manner in which such liability may have arisen. At its sole discretion, GYC Southwest reserves the right to alter, postpone or cancel any conference seminar or conference events with or without notice. Parent/Legal Guardian Agreement* By selecting “I Agree” button below, I agree that I have read and understand the provisions of this consent form in their entirety. I am not relying on the advice or interpretation of another person, besides my legal counsel, and have signed this consent form of my own volition. To the best of my knowledge, all information provided in the registration is true and accurate. I Agree Parent/Guardian's Signature*Do you have a chaperone for the child(ren)/minor(s)?* Yes I, the parent/guardian, will accompany the said child(ren)/minor(s). Chaperone's Name*I acknowledge and appoint this person as chaperone of my child(ren)/minor child(ren) from the start and at the end of the conference, with full responsibility for my child(ren)/minor child(ren) and his/her actions at all times during the entire duration of the conference. Must be 18+ or Older. Must be registered at the conference. Mr.Mrs.MissMs.PastorDr.Prof.Rev.Engr. Prefix First Last Chaperone's Phone NumberChaperone's Email* Would you like to roommate with your friends? Sure Roommate's NameIf you would like to stay with specific people, please fill out the form below and make sure your roommate(s) are/will be registered. To add more names, just click “+”. NameLast NameAge Is the parent/guardian already registered?*Babies/Toddlers and children need to be accompanied by a parent/guardian who is already registered or will be registered for the conference. Yes No Is the parent/guardian already registered?*Babies/Toddlers and children need to be accompanied by a parent/guardian who is already registered or will be registered for the conference. Yes No Is the parent/guardian already registered?*Babies/Toddlers and children need to be accompanied by a parent/guardian who is already registered or will be registered for the conference. Yes No Adult/Minor Registration (13 yrs old and up)*Please add a parent or guardian and fill out “Adult/Minor Registration (13 yrs old and up)” to register. Thank You. Go to “Add Adult/Minor Registration (13 yrs old and up)” and register. Preferred Payment Method* For Credit Card/ Debit Card users: Credit Card or Debit Card users Can Checkout Without a PayPal Account (Show me how) *Once you select paypal, please press the submit button.And you will redirected to paypal.com to complete your order Register/PayPal/Credit Card or Debit Card Register Onsite Total 1 Night/ 3 Meals Lodge RegistrationsMaximum people per lodge is 6. Any number over 6 will be staying in another lodge.Total 1 Night/ 3 Meals Cabin RegistrationsMaximum people per lodge is 6. Any number over 6 will be staying in another lodge.Total 1 Night/ 3 Meals RV RegistrationsTotal 1 Night/ 3 Meals Tent RegistrationsTotal $0.00 Early Bird PromoCongratulations! You are an Early Bird Registrant. $5 off per person 😀 Early Bird Promo – -$5 Onsite Registration Fee* Onsite Registration Fee – $20 Single RV Registration (1 Night/3 Meals) RV Registration Fee – $20 RV Registration (1 Night/3 Meals) RV Registration Fee – $20 Tent Owner Tent Registration Fee – $15 Tent Owner Tent Registration Fee – $10 Tent Owner Tent Registration Fee – $5 1 Night/ 3 Meals Lodge Early Bird PromoCongratulations! You are an Early Bird. $5 off per person ages 4 and up 🙂 Price: $0.00 1 Night/ 3 Meals Cabin Early Bird PromoCongratulations! You are an Early Bird. $5 off per person ages 4 and up 🙂 Price: $0.00 1 Night/ 3 Meals RV Early Bird PromoCongratulations! You are an Early Bird. $5 off per person ages 4 and up 🙂 Price: $0.00 1 Night/ 3 Meals Tent Early Bird PromoCongratulations! You are an Early Bird. $5 off per person ages 4 and up 🙂 Price: $0.00 Super Late Fee $20 Late Fee 1 Night/3 Meals Lodge Super Late Fee20$ Late Fee per person ages 4 and up Price: $0.00 1 Night/3 Meals Lodge Onsite RegistrationOnsite Registration Fee – $20 Price: $0.00 1 Night/3 Meals Cabin Super Late Fee20$ Late Fee per person ages 4 and up Price: $0.00 1 Night/3 Meals Cabin Onsite RegistrationOnsite Registration Fee – $20 Price: $0.00 1 Night/3 Meals RV Super Late Fee20$ Late Fee per person ages 4 and up Price: $0.00 1 Night/3 Meals RV Onsite RegistrationOnsite Registration Fee – $20 Price: $0.00 1 Night/3 Meals Tent Late Fee10$ Late Fee per person ages 4 and up Price: $0.00 1 Night/3 Meals Tent Onsite RegistrationOnsite Registration Fee – $20 Price: $0.00 HiddenPlease review all transactions. Done HiddenPlease review all transactions. Done NameThis field is for validation purposes and should be left unchanged. Δ