Heart of Texas Youth Rally 2018

Please complete this online registration to reserve a spot at the rally
Name:*
Address:*
E-mail:*
Home Phone:
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Cell Phone:*
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Birth Date:*
 / 
 / 
Grade:
Gender:
Pronouns:
Diet:*
Other Dietary Needs:
Allergies:
Other Special Needs:
Advisor(s) Name(s):
Advisor E-mail:
Estimated Time of Arrival:
 : 
 : 
Emergency Contact:*
Relationship:
Emergency Phone:*
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Congregation Name:
Congregation Address:
T-Shirt Size:*
Adult/Chaperone Section
I am a:
Payment and Submission

Youth cost is $65 before Oct. 15, $75 after. There is no charge for adults. To pay via Paypal, enter the amount in the box below and click "submit." To pay via check, leave the payment box empty and click "submit" and send check payable to First UU Church of San Antonio to

7150 W. Interstate 10, San Antonio, TX 78213

Amount:
 $ 
 .