Jubilee Registration

This form has 2 parts

Please complete both part 1 with your information and part 2 on the next page completing your down payment. Both part 1 and part 2 of the forms are necessary to completing your registration for Jubilee!

* = required field

Jubilee Registration - Part 1 of 2

Make sure to fill out the entire form and then be ready to process your payment on the next page

Name *
Email Address *
Phone Number *
Year *
Conference Accommodations *
Meal Plan Type *
Transportation *
Pursuant to the Americans with Disability Act, do you require specific aids or services?

Liability & Agreements

The following statement is a required liability waiver from the CCO (Coalition for Christian Outreach). I hereby voluntarily release, forever discharge, and agree to hold harmless and idemnify the CCO, its officers, employees, agents, or representatives, and all other persons or entities from any and all liability, claims, demands, actions, or rights of actions, which are related to, arise out of, or are in any way connected with my participation in these activities, including specifically, but not limited to, the negligent acts or omissions of the CCO, its officers, employees, agents or representatives and all other persons and entities for any and all injury, death, illness or disease, and damage to myself or to my property. I fully recognize that if anyone is hurt or property is damaged while I am engaged in any event, I will not have the right to make a claim or file a lawsuit against the CCO, or its officers, agents or employees, even if they or any of them negligently caused the bodily injury or property damage *
Date *
I AGREE THAT: The $50 down payment is non-refundable. I will pay the registration amound agreed-upon by Malone staff and myself by Februrary 7 at 4pm. If I cancel after January 31st, I am financially responsible for the full amount of the conference fee. If I cancel, any assistance I received from the Malone Jubilee Community Fund will no longer apply. I understand that if I cancel and have to find a replacement to go for me, I will be responsible for this and that Malone staff will not be responsible for this. *
Date *

Emergency Contact Information

Name of Emergency Contact *
Phone Number of Emergency Contact *
Address of Emergency Contact *

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