Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Assalamualaikum 🚨⏳ THE COUNTDOWN BEGINS ⏳🚨The Young Muslims Conference (YMC) is officially back from May 24th–26th located at The Baltimore Convention Center; 1 W Pratt St, Baltimore, MD 21201This year’s theme is “Traversing Through Time: Reflection to Realities” — an epic journey through the lessons of the past to power the future. 🪞➡️⏱️Hotel Address is the Sheraton, 300 South Charles Street, Baltimore, MD 21201Personal InformationName *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Age *Emergency Contact InformationEmergency Contact Name *FirstLastWhat is the name of your Emergency Contact?Emergency Contact Relation *What is your emergency contact's relation to you?Emergency Contact Phone *What is your emergency contacts phone number?Please list any allergies we should be aware of. (Type N/A if not applicable) *Please list any allergies we should be aware of. (Type N/A if not applicable) *ARE YOU YMC READY???? *YESYESYES - I am hassan or KarimPlease be HYPEDIf you are under 18 and need regular medication, please list below. (Type N/A if not applicable) *WaiversParent/Guardian Waiver Form (Participant Under 18 years old): I, the undersigned parent/guardian, of the above Participant understand and acknowledge that activities have risks and dangers, that may result in injury, and on behalf of myself, I hereby release and agree to hold harmless Young Muslims, its volunteers, administration, and directors, from all claims, actions, or losses related thereto. Young Muslims assumes no liability for injury, illness or damage arising from the results of participation of the above Participant. The Participant is urged to consult his physician concerning his health to participate. I, the undersigned parent/guardian for the above-named Participant hereby approve of my child’s participation in the Young Muslims Conference and consent to emergency medical treatment for my child on my behalf. *I accept the above and electronically sign this waiverWaiver Form (Participant Over 18 years old): I, the Participant, understand and acknowledge that activities have risks and dangers, that may result in injury and/or illness, and on behalf of myself, I hereby release and agree to hold harmless Young Muslims, its volunteers, administration, and directors, from all claims, actions, or losses related thereto. Young Muslims assumes no liability for injury, illness, or damage arising from the results of participation of the above Participant. The Participant is urged to consult his physician concerning his health to participate. I, the undersigned Participant hereby approve of my participation in the Young Muslims Conference and consent to emergency medical treatment. *I accept the above and electronically sign this waiverAs parent/legal guardian or participant 18 years and older, I remain legally responsible for any personal actions taken by the above named participant. I agree on behalf of myself or my child named herein to hold harmless and defend Young Muslims (YM) and Islamic Circle of North America (ICNA) its president, coordinators, directors, volunteers, or representatives associated with the event from any and all actions, claims, demands, damages, costs, expenses, and all consequential damage arising from or in connection with my child attending the event or in connection with any illness (including COVID-19) or injury or cost of medical treatment in connection therewith, and I agree to compensate the organizations Young Muslims and/or Islamic Circle of North America, its president, coordinators, directors, volunteers, or representatives associated with the event for reasonable attorney’s fees and expenses arising therewith. By signing below, I agree that the participant named below is granted permission to attend the Young Muslims Conference parallel to the ICNA Convention taking place at the Baltimore Convention Center located at 1 West Pratt Street, Baltimore, MD 21201. I, (Parent/Guardian or Participant 18 years older), sign this consent form and liability waiver and confirm my agreement to these terms and others posted. *I accept the above and electronically sign this waiverLiability Waiver: I hereby approve that if I am seen with, or have possession of, any vape, illegal drug, alcohol, weapons, or any other form of medically un-prescribed substance, whether in my belongings or luggage, that I will be immediately expelled from the conference (WITHOUT REFUND), will need to arrange transportation myself in leaving, and I will no longer be invited to any future YM Conferences. I understand that, if caught with any illegal substance, I will be reported to local authorities. *I accept the above and electronically sign this waiverI hereby warrant that to the best of my knowledge, I (participant 18 years older) or my child is in good health, and I assume all responsibility for my (participant 18 years older) or my child's health. In the event of an emergency, I hereby give permission to transport myself (participant 18 years older) or my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. *I accept the above and electronically sign this waiverAffiliation InformationPassword *Password given by coordinator or organization leadership.Sub-Region *Select your SRGeorgiaCaliforniaChicagoDallasFloridaHoustonKentuckyPennsylvaniaNew Jersey NorthNew Jersey SouthNew York EastNew York WestConnecticutMassachusettsDMVOther, Expansion, Etc.NeighborNet *NeighborNet (New Jersey North) *Select your NeighborNet (YM)Morris CountyParamusTeaneckJersey CityBayonneNewarkWayneOther/ExpansionNeighborNet (New Jersey South) *Select your NeighborNet (YM)PiscatawayEdisonWoodbridgeOld BridgeMontyboro571South BrunswickSouth JerseyBlackwoodOther/ExpansionIf you had selected the "Other" option, please list what expansion you are from *What organization do you affiliate with? *Gender *MaleFemalePayment InfoOther Org Registration Cost *Price: $40.001234567891011121314151617181920YM PackagesREG IS CLOSED - $0.00Registration is required to attend the conference. Hotel is now at capacity.New Jersey YM PackagesGOLD (Registration + 6 Person Hotel + Bus) - $180.00Bus ONLY - $80.00Registration + Bus - $110.00Hotel + Bus - $150.00Hotel are now at capacity.New York YM Packages *REG IS CLOSED - $0.00Hotels are now at capacity.Financial Aid Code ApplyIf in need of financial assistance, please reach out to your coordinator or sub-regional coordinator.Total$0.00Would you like to volunteer for YMC on-site support? *Yes - Required for Financial Aid RecipientsNoWould you like to volunteer for YMC marketing efforts? *YesNoCommentSubmit