RICUCC Youth @ Synod Registration

Space is limited to 15 youth participants per conference-Register Now!

Youth Cost is $825 (includes hotel & meals & registration)  RIC UCC is paying bus fee that is additional $120 

Complete this registration form and submit with a deposit of $150  by March 15 to reserve a spot for the trip.  

Payments will be collected in installments after the deposit is received.  

For scholarship funds and more details, Contact: Kristin Putney; mitchmoon12@hotmail.com, #774-991-1555

*First Name
*Last Name
Address 1
City
Zip
*Email
*Youth cell phone
age
Grade in school (as of January 2017)
*Date of Birth (mm/dd/yyyy)
*Parent/Guardian name
*Parent email
*Emergency contact name
*Relationship to youth
*Emergency Phone
Home church and town
Are you interested in being part of the Massed Choir and are you 16 years of age?
Yes
No
No answer
Are you interested in taking a leadership role (reader) in worship?
Yes
No
No answer
Dietary Restrictions
wheat/gluten free
vegan
no red meat
no pork
allergy to seafood
allergy to peanuts
lactose intolerant
no special diet
*T Shirt size
small
medium
large
xtra large
2XL
3XL
*Registration Deposit ($150)

Check this box to indicate that you understand a $150 deposit is required to reserve your space. This is non-refundable.

There are only 8 available
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