2012 Event Registration

Name*
FirstLast
Email Address You Check Daily / Weekly*
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone
Church You Serve with in Ministry*
Your Church Status
- Ordained Minister
- Licensed Lay Minister
- Licensed Seminary Student
- Non-Licensed Paid Staff (full or part-time)
- Other
Your Region
Type Full Name or Initials
How many years have you served in youth ministry?
Event Roommate
Due to event venue space, single rooms are not available -- so please make sure your roommate also puts your name down. If you don't have a roommate, don't worry - we will find one for you.
Are you willing to help with event leadership?
- Yes
- No
Payment
Registration isn't confirmed until we've received payment.

Please make your $300 check payable to nPartnership (the organization that sponsors DYMN and these retreats).

Mail your check to:

nPartnership / DYMN
5064 Lincoln Street
Newton, Iowa 50208

You will receive a confirmation email once you click "Register" below - and you will receive a confirmation email once we've received your payment.

If you want to reserve your spot and pay in your church's next budget year, send a $50 check now.
Comments
This field is for validation purposes and should be left unchanged.