Life Guardians Registration Saturday, February 17th, 2024 Student InformationStudent First Name(Required) Student Last Name(Required) Grade in School(Required) Freshman Sophomore Junior Senior Fall of 2023Student Cell PhoneStudent Email Address Would your student like to receive regular email updates from Right to Life?(Required) Yes No Student Home church Student's Youth Pastor Name and Contact Info (or pastor if you do not have a youth pastor) Please include email and phone number.Student T-shirt Size (Adult Sizes)(Required) Small Medium Large XLarge XXLarge Emergency Contact Name and Phone Number(Required) List any dietary restrictions Parent Information, Release Form, and Billing InformationParent First Name(Required) Parent Last Name(Required) Parent Email Address(Required) Photo Release(Required) Yes No Allows Right to Life of North Central Indiana to use photos taken during the event for marketing purposes.Release FormParent's first, middle initial, and last name(Required) Parent "Signature" - By signing, I acknowledge that I am the parent or legal guardian of the above student and that I give him/her permission to attend the Life Guardians Training on Saturday, February 17, 2024 at The Hub 1200 Kings Hwy Winona Lake, IN 46590 I have read and understand the description of this event and I release Right to Life of North Central Indiana and all other sponsors and staff from any liability resulting from illness or injury.Payment Information Once you click 'Charge My Credit Card' your credit card will be charged.Cost Price: Billing First Name(Required) Billing Last Name(Required) Billing Address(Required) 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 Payment Method*Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Total Registration NameThis field is for validation purposes and should be left unchanged. Δ
