YEC

2018

WPBC Participant Registration Form

To register for this event, fill out the form below and return it to Woodland Park Baptist Church office with your registration fee.  Registration Fee is $100.00 non-refundable for Student and Adult. The Registration Form and payments are due no later than October 21, 2018.    

Date Submitted: ___________________
Gender: _______Male   _______Female
Name: ____________________________________________
Phone: (H) __________________(C):___________________
Address: ________________________________________City:______________________State:___________ZIP:________ E_Mail:____________________________________  
Parent/Legal Guardians’ Names: ___________________________
 

Grade:  (Circle one)   7th   8th    9th   10th   11th   12th  Adult

  Participant Signature or Parent/Guardian Signature: ____________________________________________________

Total cost: $100.00 (The cost includes the conference, hotel, transportation and gas.)

Date: Sunday, November 18, 2018 – Tuesday, November 20, 2018

Rapides Coliseum, Alexandria LA

Please send this form and your registration fee to:

Woodland Park Baptist Church

Student Ministry

1909 J.W. Davis Dr.

Hammond, La. 70403