YMC Atlanta Hotel Registration FormRenaissance Atlanta Hotel | Dec 22-24 | This form is for both brothers and sister's registrationPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Personal InfoName *FirstLastEmail *Phone Number *Age *AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNeighborNet (location) *Emergency InfoEmergency Contact: Name *FirstLastEmergency Contact Phone Number *Emergency Contact: Email *Emergency Contact: Relation *What is your emergency contact's relation to you?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 YMC Atlanta 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 YMC Atlanta and consent to emergency medical treatment. *I accept the above statement and electronically sign this waiverLiability Waiver: I hereby approve that if I am seen with, or have possession of, any vape, illegal drug, alcohol, or any other form of medically un-prescribed substance, whether in my belongings or luggage, that I will be immediately expelled from the current retreat (WITHOUT REFUND), will need to arrange transportation myself in leaving, and I will no longer be invited to any future retreats. Furthermore, I hereby approve that I am subject to a search of my bag and personal belongings prior to and during the conference. I understand that, if caught with any illegal substance, I will be reported to local authorities. *I accept the above statement and electronically sign this waiverPaymentFinancial Aid Password (Ignore if you are not requesting aid)Agreed Upon Amount *PackageFull Package - $90.00One Night - $45.00Stripe Credit Card *Total$0.00CommentSubmit
