LIFE Conference 2025

Student Name

Parent Name

Parent Email

This address will receive a confirmation email

Parent Phone

Student Email

This address will receive a confirmation email

Student Phone

Gender

Male Female

Age on July 4th, 2025

Grade Completed in 2025

9 10 11 12

Shirt Size (all sizes in mens)

Dietary Restrictions

Disabilities (Hearing impaired, visually impaired, physical accessibility)

Would you like to participate in the 5k? An extra $45 will be added to your total. You do get a shirt for participating

Yes No

Student Release Form (Information and form found on the event page of ACV website)

Upload (8MB)

Medical Release Form (Information and form found on the event page of ACV website)

Upload (8MB)

I agree to support raise the entire cost of LIFE Conference as stated on the Alliance Church of the Valley website. If I am not able to raise the amount do for LIFE then I will pay the remaining amount out of pocket. If I decide I no longer want to or no longer can attend LIFE Conference after November 20th, 2024 I will still pay the entire amount due for LIFE to Alliance Church of the Valley

I agree

Payment (10% out of pocket used as a commitment to support raise) - Registration not complete until payment is submitted. Early Bird downpayment must be turned in before the early bird deadline, otherwise regular rates will be applied to your registration. Please make checks out to Alliance Church of the Valley and put "LIFE Conference" in the memo do NOT put their name in the memo please. Then put the check or cash in an envelope that says LIFE Conference and your students name.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

LIFE Conference 2025

Description

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