Youth for Life Registration
First Name
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Last Name
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Phone
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Email
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Church/Organization
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Region
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What city/region are you in?
Albuquerque, NM
Birmingham/Tuscaloosa, AL
Boise, ID
Central PA (Harrisburg)
Central PA (York)
Central PA (Lancaster)
Charlotte, NC
Chicago, IL
Denver/Boulder, CO
Detroit, MI
Fayetteville, NC
Greenville, SC
NorCal - Antioch, CA
NorCal - Modesto
NorCal-Sacramento
NorCal - Stockton
Northern VA
NYC
Olympia, WA
Ontario, OR
Roanoke, VA
Seattle, WA
SoCal - Orange County
SoCal - Pomona/Upland
SoCal - Riverside/Corona
SoCal - San Bernardino/High Desert
SoCal - San Fernando
SoCal - Santa Barbara
SoCal - Ventura County
SoCal - Vista
South Florida
Triad, NC (Greensboro/WS)
Triangle, NC (Raleigh/Durham/Chapel Hill)
Whatcom County, WA
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Individual or Group Registration
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Individual
Group
If registering a group, how many people will be joining you?
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