a registration form

Transcription

a registration form
GET SMART 2015
Get Smart, part of Arise conference, is a youth conference for intermediates and High Schoolers and is all about spending three days being inspired and empowered. With incredible speakers and crazy hangouts, it is a conference you don’t want to miss! Get Smart has been a massive milestone in many of our leaders lives and we can’t stress it enough ‐ if you can be there, BE there. You will not regret it! The conference runs from the 16th to the 18th of July and registrations cost $80. We will be staying in the Barn at Silverstream Retreat over the course of the conference so each person will need to bring their own bedding (including a mattress). If you do not wish to stay on site with us you will need to be at Silverstream Retreat no later than 7:45am on Friday and Saturday mornings. Breakfast will be provided, however all other meals are to be paid for separately by the attendee. Please complete the following permission slip and return as soon as possible. A programme outline, gear list and all other information will be sent out when the permission slip has been received. Full payment is due by Friday 3rd July. Judith Fairbrother (E) [email protected]
Get Smart Youth Conference 2015 Permission Slip Full name: ……………………………………………………………………………………… Address:…………………………………………………………………………………………. Phone Number:…………………………………………………………………………….. Emergency Ph:…………………………………………………………….………………….. Medical information……………………………………………………………………… Staying on‐site (circle one) YES/NO Payments: Please attach cash or cheques to this form and return to Judith Fairbrother or post to 3 Reynolds Bach Drive Silverstream. (Cheques should be made payable to ‘LifeSwitch’.) For Direct Credit/Internet payments please credit the LifeSwitch bank account 06‐0545‐0014111‐26. Please include your name and “Get Smart” as the reference. For Credit card (Visa or Mastercard only) ‐ please complete the following: Please debit my credit card in the amount of $__________ □
Card type: Visa □ Mastercard Name on card: ______________________________ □□□□‐□□□□‐□□□□‐□□□□ Card Number:
Expiry date: ____/_____ Signature: ________________________ Parents/ Guardians please complete the following section if the attendee is under 18 years. I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Give permission for . . . . . . . . . . . . . . . . . . . . . . . . . . to go on the Get Smart Youth Conference trip from the 16th to the 18th of July. I understand that the leaders may have to make decisions in relation to his or her safety on my behalf including Medical treatment. I accept responsibility for any accident or loss of property caused by my child. Signed………………………………………… Date…………………… 

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