FAST AND SECURE ONLINE REGISTRATION
It's simple... here's how it works: Fill out the form completely and hit "Submit". A confirmation will automatically be sent to you via e-mail, so please be sure to enter your e-mail address. With that e-mail will be a Acrobat PDF attachment. Get the proper signatures on that form and mail it all back to our office as soon as possible.

Total Package Registration:
1. Regular – Feb. 11, 2008 to April 1, 2008….$410 USD / $485 CAD
2. Late after April 1, 2008….$460 USD / $540 CAD

PERSONAL INFORMATION
This registration is for:	Youth Adult
First Name
Last Name
Address
City
State/Province
Postal Code
Country	United States Canada
Phone	( ) (xxx) xxx-xxxx
E-mail
Gender	Male Female
Birthdate	/ / mm/dd/yy
Church
Church City city	(Please use the city found in the church mailing address)
T-shirt Size	S M L XL XXL
EMERGENCY CONTACT
Name
City, State/Prov
Day Phone	( ) (xxx) xxx-xxxx
Evening Phone	( ) (xxx) xxx-xxxx
Cell Phone	( ) (xxx) xxx-xxxx
ROOMMATE
You may identify one person with whom you want to share a room. YU will select a roommate for persons who do not specify one.
Name
INSURANCE/MEDICAL
Insurance Company
City, State/Prov, P. Code
Phone	( ) (xxx) xxx-xxxx
Subscribers Name
Policy #
Group #
Provincial Health Insurance # (Canada)
Does your insurance company require pre-authorization for medical treatment? YES NO
Medical conditions, including allergies
List medications you take regularly
YOUTH APPLICANTS ONLY
School
Grade completed by 7/20	-- Select A Grade -- Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 College Level
Please send me talent audition form
Please send me advanced seminar information
ADULT APPLICANTS ONLY
I will attend as:	Small Group Leader (SGL) Participant
For SGLs: Have you served as a Small Group Leader before? YES NO .... If so, how many years?
Gender Preference for small group? Male Female Either
I would prefer to lead a group with my roommate alone assign someone with me
I wish to assist in the Prayer Place YES NO
FINISH THE REGISTRATION
Do you have any notes for Youth Unlimited about this registration?
You are required to supply full payment with this registration. If you are using a pre-registered spot, please enter the pre-registration number below, and pay the remaining balance. If you are paying by check, and are unsure of what your balance is, please e-mail or call our office.
Pre-registration Number (if using a pre-registered spot)
Payment	Credit Card Check (If paying by check, payment should be to the YU office within 2 weeks of submitting this registration)
Credit Card Number
Expiration Date	(mm/yy)
Name on Card