Please enable JavaScript in your browser to complete this form.Use this page to register for 2023 Annual Gathering (Friday-Sunday) as well as the Chaplains’ Retreat (Thursday) in Atlanta. Location: Oakhurst Baptist Church, Atlanta, Ga. Dates: April 21-23 – Annual Gathering, April 20 – Chaplains’ retreat Please complete this form for each individual registering. Children must be registered so we can plan for meals and staff. The deadline to register is April 16, 2023. Are you or your organization interested in participating in the exhibition hall at the Annual Gathering? Register your organization here! * = required field Registration InformationChaplains' Retreat – Thursday, April 20, 2023 from 1:00 – 5:30 pm *I will attend in-person – $25.00I will attend the Zoom Virtual Version – $15.00No, I will not attend – $0.00Annual Gathering *CLOSED: Early Bird Full Adult Registration (by April 1) – $125.00Full Adult Registration (April 1-16) – $175.00First Time Attendee – $50.00Student (College and Grad School) – $50.00It’s Rough Out There – $50.00Workshop Leader (Free) – $0.00Child ages 6-12 and Youth 13-17 (Free but they must be registered) – $0.00Child attending provided childcare for children ages 5 and under – $25.00No, I will not attend – $0.00Child/Youth Name *FirstLastAge on April 20, 2023 *Child/Youth Dietary Restrictions *Scholarship AssistanceThe following tax-deductible gift is to offer registration at low cost for those for whom finances are a barrier to attending the gathering. Gift Amount$25.00$50.00$100.00Other amountAdditional InformationThese items are optional but still really important. Please share your date of birth with us. (This is for information purposes only as we try to collect some demographic data about the Alliance. This will not be shared with anyone.)Disability Accommodations (If you need hearing, visual, mobility, or other accommodations, please indicate below)Dietary NeedsDo you need any of the following services?Sign Language InterpretationSpanish Language InterpretationPortuguese Language InterpretationIf you are part of a congregation, to which church do you belong?Participant InformationName *FirstLastPronouns *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Do you want to be added to our mailing list? *YesNoI’m already on itPhone *Is this your first in-person Annual Gathering? *YesNoName you want to appear on your name tag (if different than above)Church or Organization Affiliation you would like to appear on your name tagStudent InformationIf you are registering as a student, please provide the following information: Name of College / Grad SchoolGraduation YearCancellationsRegistration will be refunded with written notice received by April 1, 2023 less a $25 processing fee. Payment InformationTotal$0.00Credit Card *CardName on CardSubmit
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