Family Registration Form
To register, complete the form below and submit the registration. When you submit your registration, a confirmation page will be displayed and you will have the opportunity to pay for your registration online. If you do not see the confirmation page, please reregister.
Delegate
Information
* - required field
first name
*
last name
*
division
<select division>
Adult Rehabilitation Centers Command
College for Officer Training
Eastern Michigan Division
Heartland Division
Indiana Division
Kansas and Western Missouri Division
Metropolitan Division
Midland Division
National Headquarters
Northern Division
Other
Retired Officers
Territorial Headquarters
Western Division
Western Michigan/Northern Indiana Division
Wisconsin and Upper Michigan Division
corps
<select corps>
Not applicable
Emergency Contact
name
*
phone
*
hotel
address:
*
city:
*
state:
ALABAMA
ALASKA
ARIZONA
Outside U.S.
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DC
FLORIDA
GEORGIA
GUAM
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PALAU
PENNSYLVANIA
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGIN ISLANDS
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
*
zip:
*
phone
*
e-mail
*
Other Family Members
Register Spouse
First Name
Last Name (if different)
Number of children to be registered:
0
1
2
3
4
5
6
7
8
9
10
Check the box below if you are an officer registering children (infant - Age 14) for care during Officers' Councils
Childcare during Officers' Councils
First Name
Last Name (optional)
Birth Date
Regular (Before 05/07/2010)
Late or
On-site
Number Ordered
Amount Due
Registration
Fees Due
All persons attending Congress, including children, must register and pay the registration fee.
Childcare is available at an additional cost with pre-registration only.
$40
$50
0
$0.00
Additional fees for Childcare
Ages Infant - 23 mos (Nursery)
$25
N/A
N/A
$0.00
Ages 2 - 5 years (Toddler)
$25
N/A
N/A
$0.00
Ages 6 - 11 (Child)
$25
N/A
N/A
$0.00
Seating
No assigned seating or tickets, admission by arm band only. Reserved seating will be available for special guests and cadets' families at specified times.
Saturday
Lunch
Delegates will be provided a picnic lunch on Saturday at Noon. Please indicate how many meals of each type you would like to order below.
Hot Dog
Hamburger
Green Salad
Other Events
Number attending the Friday Teen/Young Adult Afterglow
The Teen and Young Adult Afterglow will be a Dodgeball / Kickball Spectacular and will take place at the Schaumburg Sport Center on Friday, June 11th from 9:30 pm -12 am. This event is open for ages 13-29 years old and buses will be provided for first 200 participants.
Number attending the Sunday Bible Study on Holiness
Extra Programs and Tickets
Number
ordered
Cost
Due
Friday evening
$15.00
$
0.00
Saturday evening
$15.00
$
0.00
Sunday afternoon
$15.00
$
0.00
Congress Program
$10.00
$
0.00
Total Amount Due
$0.00