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Registration: Regional Assembly 2017

 

Please be sure to compete ALL the steps for registration, including the CHECKOUT process to the step that shows you the "thank you" message. If you do not receive an emailed acknowledgment of your registration within one hour, please contact our office immediately, tech@midamericauua.org.

After registering one person, you will be able to add others before checking out.

Internet Explorer users please note: we had a report that multiple registrations were not adding to the Cart! Please consider using another browser like Chrome or Firefox.

Payment options are "Mail in check" or "Pay by credit card." We process credit card payments through PayPal.

Scholarship requests must be in by the Early bird date.

USER INFORMATION
Title:
First Name:
Last Name:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Email:
Confirm Email:
Congregation:

Dietary and Accessibility Needs

Please list any accessibility or special needs.:
Dietary Preference:
Please note: If you have dietary requirements beyond vegan, vegetarian, and gluten free options, we may not be able to satisfy them. Please consider bringing what you need to ensure your food requirements are met.
If you have food allergies, please list them here:
Are you planning to be here for Saturday dinner?:
Yes  
No  

Please choose the Registration Type for this person.

If you are registering someone else, please make sure it is THEIR name and not yours in the First and Last Names above.

Please note: Children ages 3-12 will be enrolled in the Children’s Program. Must register before April 5.

REGISTRATION TYPE:
Adult ...$165  
Young Adult (18-35) ...$140  
Youth (13-17) ...$100  
1st Child... $100  
2nd Child... $75  
3rd and more: no additional charge  
Children (0-2) (no childcare available) ...no charge  
Volunteer (work 2 hours) $145  
MidAmerica Staff and Board...$165  
1

PHOTO RELEASE

I hereby authorize the MidAmerica Region of the UUA (“the Region”) to make use of my appearance in photographs, audio, and/or video recordings (hereafter, “media”). The Region shall have complete ownership of the media. I grant the Region the right to use it with no restrictions or claims, including, but not limited to, the right to edit, use, and reuse the media as the Region deems appropriate. I also hereby release the Region and its officers, employees, agents and volunteers, from all claims, demands, and liabilities whatsoever in connection with the above.

I agree with the photo policy:
Yes  DO NOT AUTHORIZE  
Whose name is on the check or credit card you're paying with?:
Person being registered  
Someone else's  
OPT OUT: May we share your name and e-mail with other participants?:
Yes  No  
Comments or extra instructions to registrar:

Please type the letters you see

so we know you're not a spam robot. Thanks!

Enter the Security Code:
I agree to the terms and conditions:
Read Terms & Conditions

Registration Instructions - Important!

Please be sure to complete ALL the steps for registration, or we won't receive the information.

Be sure to choose a payment option: Payment options are "Mail in check" or "Pay by credit card." We process credit card payments through PayPal.

Fill in the Security Code, and click the TERMS AND CONDITIONS link next to the checkbox to read important terms and conditions. Then close the window and check the box to indicate you have read them. These are necessary steps in completing your registration. PLEASE NOTE: If you click the "BACK" button after proceeding to the next step you will have to re-enter your e-mail address.

You must complete all the steps to the end, including the CHECKOUT process, to the step that shows you the "thank you" message.

After registering one person, you will be able to add others before checking out.

A RED ASTERISK * = Required field. If you see the same page after clicking GO TO THE NEXT STEP, check to see whether you have filled out all the required fields.

If you do not receive an emailed acknowledgment of your registration within one hour, please contact our tech support, tech@midamericauua.org.