Genesis Registration

"*" indicates required fields

Please fill out the information below to register

Name*

First Last

Phone*

Email*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Parish*

Age*

How did you hear about the conference?*

Today's Date

Do you have or are you a high school student who will be joining the conference

Yes

Cost Per Person (If Not A High Schooler)

Payment includes breakfast and lunch...

Price: $40.00

Cost Per High Schooler

NOTE: Please bring the high school ID of the person registered so that we are able to verify them being in high school

Price: $10.00

Names of Attendees

Please add names of attendees including yourself if you buy 2 or more tickets.

Subtotal

$0.00

Please check below if you would like to help ECRC in covering the 3.5% credit card fees

YES

CC Processing Fees

Price: $0.00

Total

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

CAPTCHA