Saturate Conference Virtual @ N3C November 11-13

TRIBE Member

Name

This address will receive a confirmation email

Cell Phone

TRIBE Parent/Guardian

Parent/Guardian Name

Address

Emergency Phone Contact

Parent/Guardian for Under 18

I, the parent or legal guardian of the youth named above, do hereby consent to the participation of my youth in the TRIBE Saturate Conference . I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached, I authorize Pastor Anthony to aid in and/or find a medical professional to provide any necessary medical services in the event that my youth is injured or becomes ill.

Medical Information

Health Insurance Company

ID#

Group ID#

Payment Information

Payment $25 Per Person

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

November 11-13

Saturate NY Conference
LiveStream @ N3C

Saturate Conference Virtual @ N3C November 11-13

Description

Please Fix the Following