TheRise Registration Registration application for TheRise Youth Conference 2019 Student Contact InformationName* First Last Parent or Guardian Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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 InformationMember of FBCL? Yes No Member of Another Church?Student is a Guest of:Age*Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender*MaleFemaleStudent's SchoolGrade LevelT-Shirt SizeSmallMediumLargeXL2XL3XLRelease Agreement, Image Waiver, & Time Away FormsDownload the Parent Packet and 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 RELEASE FORMForm UploadPlease upload your completed forms here. Drop files here or Accepted file types: jpg, gif, png, pdf, doc, docx. Registration FeesRegistration for The Rise is $75 per applicant. **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.$75.00 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.NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.