Congregation Name     

Congregation Phone Number  

Mailing Address  

City    State     Zip Code

Congregation's Email Address    

Group Leader's Name     

Group Leader's Phone Number 

Group Leader's Email Address    

Boy's Attending.  Please Indicate Grade

Girl's Attending.  Please Indicate Grade

Adults Attending.  Please Indicate Couples

Total Number of Teenagers    x $15.00 or $20.00 if Registering After October 1st.

Total Number Of Adults    Adults' Registration Free

Total Number Of Football Tickets    x $12.00

Housing

Housing Required For Friday Night (check) -   Yes    No

Housing Required For Saturday Night (check) - Yes         No

Please List Any Special Housing Needs, Requests, Or Prior Arrangements

T-Shirts
T-shirts are included in the teens' registration fee. 
Adults can purchase T-shirts for $10.00 each
Child sizes are not available.

Number of Small      Number of Medium      Number of Large    

Number of X-Large      Number of XX-Large

Total Number of Adult T-shirts -  X $10.00.  (Sizes should be included in the figures above.)

Total Of Check Being Mailed 

PLEASE REMEMBER THAT YOU ARE NOT FULLY REGISTERED UNTIL YOUR CHECK IS RECEIVED!
Please mail your check to:

Starkville church of Christ,
Discover Youth Rally
1107 East Lee Blvd. 
Starkville, MS 39760