Teens Write Registration

Teens Write Form Registration

Saturday May 19, 2018

9:45 am - 3:45 pm



Walk-ins are welcome!

NOTE: There is no additional charge or need to register if you are already registered to attend the conference on Saturday.

Date:   mm/dd/yyyy format
First Name:
Middle Initial:
Last Name:
Address:
 
City:
State:
Zip:
Phone: format (999)999-9999 (only enter the numbers)
Email:
Church:
School:
Age:
   

PERMISSION TO ATTEND
By providing my contact info below I give permissiion for my son or daughter to attend Teens Write. In the event of an emergency , if I cannot be reached , I grant permission for my child to receive medical care.
Parent Name:
Parent Home Phone: format (999)999-9999 (only enter the numbers)
Parent Cell Phone: format (999)999-9999 (only enter the numbers)
Parent Email:



Please tell us how you learned about Teens Write!
 
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Public School Students $45
Homeschooled Students $33 (25% discount)
Christian School Students $33 (25% discount)
Do you have a FREE PASS to cover registration? 
 
If you have a free pass to cover your registration fee, please note that below and where it is from (your school, KPOF, scholarship...)
 
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Additional $15 YMCA commuter fee if you are not a Y member (no fee for 12 and under)
Lunch in Aspen Dining Room $11
12 and under - lunch $7.50
Meals are $1.00 more if purchased in the dining hall.

Scroll to bottom to submit.

Parents, Teachers, Pastors
Please register me to attend the following workshop(s) during Teens Write at $25 for one, $45 for two,  $65 for three, plus $15 YMCA Daily Feefor non YMCA members who are not staying on campus.

You are welcome to attend the morning and evening keynotes free of charge.  No registration needed for keynotes.

Saturday, 10:45 - 11:45  
Saturday, 10:00 - 2:30  
Saturday, 2:45 - 3:45  
   
First Name:
Middle Initial:
Last Name:
Address:
 
City:
State:
Zip:
Day Phone: format (999)999-9999 (only enter the numbers)
Night Phone: format (999)999-9999 (only enter the numbers)
Cell Phone: format (999)999-9999 (only enter the numbers)
Email:
Church:
Additional $15 YMCA commuter fee if you are not a Y member
Lunch in Aspen Dining Room $11
Meals are $1.00 more if purchased in the dining hall.

Payment Options
I will use PayPal.  (You do not need a PayPal account. Click button on the next page.)
I prefer not to pay online. Instead I will call 484-991-8581 with my credit card info.
I will pay by check. (Please make it payable to CCWC and mail to Marlene Bagnull, 951 Anders Road, Lansdale, PA 19446.)


Verification Check:






Type the characters that you see in this picture.


You must type in the verification code and hit "Submit" below to complete your registration.