COUNT ME IN 2022-More Information Please

March 4-6, 2022 | COUNT ME IN 2022

Converge 2022 is here! The date of the conference is March 4-6, 2022. We are back at Woodlands Camp this year for what will be the best retreat ever. The cost is $165 which includes registration, lodging, meals and t-shirt. Fill out this form and a Converge Representative will contact you with more information and your next step. We can't wait to worship with you!

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Students Name

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Gender

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Please select one option.

Male Female

Grade

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Please select all that apply.

6 7 8 9 10 11 12 Not in School

What Church do you currently attend?

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T-Shirt Size

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Students Email

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This address will receive a confirmation email

Students Cell Phone

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Parent Cell

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Address

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How did you hear about us?

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If someone invited you to Converge, please list their name.

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EMERGENCY INFORMATION

Emergency Contact (name):

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Contact Number:

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Allergies:

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Special Medical or Dietary Needs:

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Insurance Company:

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Policy Number:

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Family Doctor:

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I acknowledge that filling out this form doesn't guarantee my spot at Converge Conference. A Converge representative will contact you with information and next steps to becoming a Converge participant as well as payment options.

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Please select all that apply.

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March 4-6, 2022

COUNT ME IN 2022

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