Today's Date

Name*

First Last

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Have you changed addresses in the last year?

Yes
No

Previous Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Email Updates

Receive Family Conference Email Updates

Phone*

Conference Registration*

Family ($295)
Individual ($95)
Previous Conference Attendee ($0)

Early Registration*

Register at least one month early (May 29) to receive the early registration discount!

Family ($250)
Individual ($80)
Previous Conference Attendee ($0)

First Time Attending a Conference*

Yes
No

Previous Conference Attended*

Big Sandy April Family Conference
Northwoods June Family Conference

ATI Family ID#

Families enrolled in ATI receive a $100 discount on their registration

Special Session

Please let us know if you plan to attend the following session.

Single Parents Luncheon

Family Information

Spouse*

Attending
Not Attending

Spouse's Name

First Last

Children Attending

Name	Gender	Birthdate	Program Cost	Actions
				Edit Delete
There are no Children.

Maximum number of children reached.

Programs Total

Price: $0.00

Cost for Children Attending

Emergency Contact Number*

Cell phone number to contact in case children's program leaders need to contact you

Emergency Contact Person*

First Last

Secondary Emergency Contact Number*

Second cell phone number to contact in case children's program leaders need to contact you

Emergency Contact Person*

First Last

Sign-out Permissions*

I give permission for my children 12 and older to sign out their younger siblings.

Yes
No

Sign-out permissions for additional individuals

I would like additional individuals to have permission to pick up my children from their programs. (Limit 3)

Individuals with Permission

Name	Actions
	Edit Delete
There are no Individuals with Permission.

Maximum number of individuals with permission reached.

Release Form

*

View the Release Form

I have read and agree to the Release Form

Total Amount

Registration Total

$0.00

ATI Family Discount

$0.00

Amount we are sowing

All funds designated in this field are used to assist families who are under special financial strain. This provides you with the opportunity to experience the rewards of sowing and reaping that God promises: "He which soweth bountifully shall reap also bountifully" (II Cor. 9:6), and "Give, and it shall be given unto you" (Luke 6:38).

Total

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Modesto Registration

Family Information

Release Form

Total Amount

Events for Families

Courses for Young People

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