State Youth Conference

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Name

*

Birthday

*

Grade

*

Please select one option.

7th 8th 9th 10th 11th 12th

Adult T-Shirt Size

*

Please select one option.

S M L XL

Address

*

Parent's Email

*

This address will receive a confirmation email

Parent's Phone Number

*

Emergency Contact Phone Number

*

Church Name (if applicable)

$50 Non-refundable deposit can be dropped off to the FBC Office or mailed to FBC 812 Lassen Lane Mt. Shasta, CA 96067

Description

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