East Texas Rise Registration 2023 Student registration application for The Rise Youth Conference 2023. "*" indicates required fields Contact InformationName of Student* First Last Parent or Guardian Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent / Guardian Phone*Student's PhoneCan the student receive text messages? Yes No Student's Email Student InformationIs the student a member of FBCL?* Yes No Member of Another Church? Student is a Guest of: Gender* Male Female Age* Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student's School Grade Level* T-Shirt Size* Small Medium Large XL 2XL 3XL Release Agreement, Image Waiver, & Time Away FormsDownload, complete, and upload or return the release forms below. Upload the completed forms using the field below. The Time-Away form is only for those students that will be leaving theRise early. Your registration is not complete until these waivers have been successfully submitted either below or in-person. Download Medical Release Form Download Time Away Form What to Bring Sheet Form UploadPlease upload your completed forms here. Drop files here or Select files Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 50 MB. Registration FeesEarly Registration for The Rise is $60 per applicant through December 31. **If you have credit available, select "Other" and you will be asked to input an amount. Please verify your credit with Vickie Brewer in the Church Office at (903) 212-3306. If you are selecting "Pay In-person", please contact Vickie Brewer once you have submitted your form. Registration Fee*All online payments will be processed via PayPal.$70.00 RegistrationOther (**Only for students with Credit Available)Pay In-PersonTotal Amount Due (Less Your Available Credit) *This field is only for students applying credit from their FBCL account.PhoneThis field is for validation purposes and should be left unchanged.
