FYC2015





Family & Youth Conference 2015 Registration Form


Primary Registrant


First Name *
Middle Name
Last Name *
Gender *
Contact Number *
Contact Number - Cell *
Age Group *
Grade (if applicable)
Email *
Parish (and Location) *
Parish Vicar *
Street Address *
City *
State *
Zip Code *
Emergency Contact's Name *
Emergency Contact's Number *
Emergency Contact's Relationship *
T-Shirt Size *
Do you have dietary restrictions? *
Any Food Allergies? *
If Yes, Please describe

Conference Rates


Adults (Age 10+) - $190
Children (Ages 3-10) - $95
Children (Ages 0-3) FREE


Make check payable to “Diocese of South-West America” & Reference “FYC 2015” In the memo line.

Mail check to: ST PAUL’s ORTHODOX CHURCH (FYC 2015),2424 Barranca Way, McKinney, TX-75069.

( All these details will be send to your email address given above upon completion of registration )

Participant No.1
Full Name
Gender
Age Group
Grade
T-Shirt Size
Any Food Allergies?
If Yes, Please describe
Do you have dietary restrictions?

Participant No.2
Full Name
Gender
Age Group
Grade
T-Shirt Size
Any Food Allergies?
If Yes, Please describe
Do you have dietary restrictions?

Participant No.3
Full Name
Gender
Age Group
Grade
T-Shirt Size
Any Food Allergies?
If Yes, Please describe
Do you have dietary restrictions?

Participant No.4
Full Name
Gender
Age Group
Grade
T-Shirt Size
Any Food Allergies?
If Yes, Please describe
Do you have dietary restrictions?

Participant No.5
Full Name
Gender
Age Group
Grade
T-Shirt Size
Any Food Allergies?
If Yes, Please describe
Do you have dietary restrictions?

Participant No.6
Full Name
Gender
Age Group
Grade
T-Shirt Size
Any Food Allergies?
If Yes, Please describe
Do you have dietary restrictions?

ACCOMMODATION SECTION - PRICE PER ROOM : $390
Are you Flying In *
Need Accommodation *
Total Rooms
Total Accommodation Cost
PaymentMode

REGISTRATION/CONFERENCE GUIDELINES


    • Registration will open on Sunday Dec 28th 2014. Last day of registration will be Friday May 15th 2015 .
    • Mandatory fields / sections are marked with an asterisk*. All mandatory information should be provided on the registration form.
    • Full Payment should be paid with the Registration Form. Registrations with partial payments will not be accepted.
    • Completed form with full payment should be mailed to: ST PAUL’s ORTHODOX CHURCH (FYC 2015),2424 Barranca Way, McKinney, TX-75069. Make check payable to “Diocese of South-West America” & Reference “FYC 2015” In the memo line.
    • Registration is NON Transferrable.
    • Special requests or needs (dietary, allergy, disability etc.) must be stated in the space provided on this form. The conference committee will try their best to accommodate your special needs.
    • Conference will be held at InterContinental®, 15201, Dallas Parkway, Addison, Texas 75001.
    • The nearest Airports are Dallas Fort Worth Airport (DFW) and Dallas Love Field (DAL).
    • Conference registration and accommodation fees are non-refundable. Fees will not be reduced/refunded for partial attendance or missed meals.
    • The Conference Committee may ask a participant to leave the conference if he or she violates any of the rules mentioned herein, as well as those delivered in writing or as general announcements during the conference. Any questions, comments or concerns should be brought to the attention of the Conference Director/Secretary or any other members of the Conference Committee.
    • For any enquires contact Conference Director Rev Fr Mathew Alexander 314-265-1046 or Secretary Mr Elson Samuel 214-449-8556.

      • RULES & REGULATIONS

      Please read and check the the box below. Your agreement indicates that you understand and acknowledge to the following:


    • I agree that neither I nor anyone registering on this form will bring any alcoholic or illegal substances onto the conference site. If participants are found with such items, appropriate action (including contacting parents of minors, vicar, and police) will be taken by the Conference Committee.
    • I understand that by signing this form, I am consenting that the images and video recordings of myself and my family members taken during the conference will be the property of the Diocese of South-West America of the Malankara Orthodox Syrian Church. I agree that these images and videos may be used by the Diocese of South-West America for a variety of purposes without further notification.
    • I understand that I alone am financially and legally liable for any damage done to the facilities and/or properties at the conference site by myself and/or those registering on this form.
    • I acknowledge and accept the responsibility for the safety, liability and medical insurance for myself, my family and those registering on this form.
    • I understand that parents and guardians are responsible for minors (Age 17 or under).
    • I understand that any and all valuables brought to the conference facility by a participant are his/her sole responsibility. The Family Conference Committee & Diocese of South-West American will not be held responsible or provide any reimbursement for any lost items.
    • All participants should dress respectfully and conduct themselves in a manner appropriate for a religious function. Participants should be respectful towards each other. Any form of physical aggression towards any individual is strictly prohibited.


I agree to all FYC2015 Guidelines, Rules & Regulations stated above *
If you selected Paypal Option then details about how to proceed with the payment will be displayed in the confirmation page

Malankara Orthodox Syrian Church,Diocese of South-West America, 3101 Hopkins Rd Beasley, TX 77417 Ph: 281.403.0670 · Fax: 281-459-0814

Copyright © 2009 Diocese of South-West America. All Rights Reserved.