Event Registration
Church Name
*
Church City
*
Association
*
Contact Name
*
First
Last
Church Position (Staff member, volunteer, etc.)
*
Contact Phone Number
*
Email
*
Address
*
Street Address
City
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Armed Forces Americas
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State
ZIP Code
Can we email you updates from the Office of Collegiate & Student Ministries
*
Yes
No
Do you need a deaf interpreter?
*
Yes
No
Do you need reserved wheelchair access?
*
Yes
No
What size shirt does the youth leader wear?
*
Small
Medium
Large
Extra Large
XL
2XL
3XL
Will you need a special provision for your students? If so, please specify below.
*
How many people are you registering for Speak 2021?
*
Price:
$40.00
Quantity:
How Will You Be Paying?
*
Credit Card
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Total
$0.00
Credit Card
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Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
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2033
2034
2035
2036
2037
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2040
Expiration Date
Security Code
Cardholder Name
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