Southwest Youth Conference
Hosted by St. Pius X Life Teen Youth Ministry

GROUP LEADER REGISTRATION FORM

IMPORTANT INFORMATION					MAIL TO:
1.	Please type or print clearly.	South West Teen Conference
2.	State if a member in your group is disabled,	LifeTeen Youth Ministry
In a wheel chair or requires special assistance.	ATTN: Hector Clemente
3.	Your written signature is required (see below).	9024 El Dorado
4.	NO REFUNDS	El Paso, TX 79925
		915-592-2700

Group Leader/Confirmation Teacher Information:

Prefix_____ First Name___________________________________ Last Name_____________________________________

Group Name/Organization /Parish:_______________________________________________________________________

Address: ______________________________________________________________________________________________

City ____________________	State/Prov ___________	Zip/PC ____________   Diocese: ___________________________

E-mail _______________________________________________________________________________________________

Day Phone# (___)____________________ Evening Phone# (___)___________________ Fax#(___)___________________

Special Needs: _______________________________________________________ Wheelchair/Handicap:______________

Note:	With the exception of Group leaders, ALL cell phones and pagers MUST be turned off at all times during conference activities. If you are expecting a call, please let one of the hospitality or staff members know at time of registration or before conference activities.
                       Please submit a list of ALL cell phone or pager #’s that will be with you during the conference.

Registration Fees:	$25.00 per participant	$30.00 late fee 	$10.00 t-shirt fee

Early Registration-Total # Youth, Adult and Handicap Attendants: ______ x $25.00 = $ _______ = TOTAL FEES

Late Registration– Total # Youth, Adult and Handicap Attendants: ______ x $30.00 = $ _______ = TOTAL FEES

Total # Youth and Adult T-Shirts: ________ x $10.00 = $ _________ = TOTAL FEES
 ______ Small      _______ Medium         ________ Large       ________ X-large      ______2X-large  ______Other         

Total # Priests Attending: _____________          FREE (See special instructions for Priests form)

EARLY $25.00 & $10.00 T-Shirt REGISTRATION TOTAL BALANCE DUE

*  *  LATE $30.00 & $10.00 T-Shirt  REGISTRATION TOTAL DUE

	I have read and understand the non-refundable policy as outlined in the registration packet.
	X	All payments are non-refundable.
	X	All insufficient fund checks - $25.00 handling fee plus any other charges will be accessed to your attending                          organization /group and will be your sole responsibility to pay within 10 days.

			________________________________
                  			     (group leader signature)

Method of Payment:		* CHECK # _________   * MONEY ORDER # _________
		Make Checks/Money Orders Payable to:   St. Pius X Life Teen Youth Ministry

Group Name/Organization/Parish_________________________________________

Group Leader/Confirmation Teacher’s Name_______________________________

		Males							          Females

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