The Vine Conference Registration Register for The Vine ConferenceWe will not sell or otherwise disclose to third parties the information you provide via this registration form. Providing contact information will enable us to send you information about our next event or contact you should we have questions about your registration.Registration Type* Individual Registration Group Registration Individual InfoParent Name* First Last Address* Street Address Address Line 2 City AAAEAKALAPARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY State ZIP Code Cell Phone*Parent's Email*To receive registration confirmation Student's Email*To receive registration confirmation Church InfoChurch*Church Address* Street Address Address Line 2 City AAAEAKALAPARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY State ZIP Code Church Phone*Church Website Sponsor Info*Sponsor NameCell PhoneEmailGender Student InfoSr. High Students/Grade*click + to add more/click - to removeStudent NameLast NameGradeGenderT-Shirt Size Sleeping Arrangements*Dorms are first come first serve. Once we run out of room, we will ask that you make hotel reservations. Dorm Room (if available) Hotel Comfortable staying in dorm room with LCU students?*If no, your group will be placed in dorm room(s) with only other members of your group. Yes No Interested in hearing more about LCU Send me info Total number of students attending The Vine Conference* Price: $30.00 Quantity: $30 on or before March 7 & $35 on or after March 8. Sponsors are FreeTotal $0.00 Payment Type* Pay with Credit Card Pay with PayPal Pay by Check Billing Email* Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaAPO-AEArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia-HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo, Democratic Republic ofCongo, Republic ofCook IslandsCosta RicaCote D'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEnglandEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFederated States of MicronesiaFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupe (Fr.)Guam (US)GuatemalaGuernseyGuineaGuinea BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (North)Korea (South)KosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartinique (Fr.)MauritaniaMauritiusMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherland AntillesNetherlandsNew Caledonia (Fr.)New ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRussian FederationRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Tome and PrincipeSaint Vincent and GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican City StateVenezuelaVietnamVirgin Islands (British)Wallis and FutunaWestern SaharaYemenYugoslaviaZambiaZimbabweOther Country Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name By submitting this form, I agree that I (and my group) will follow any and all of LCU's COVID-19 guidelines that are set forth prior to and at the event. (COVID-19 guidelines will be emailed upon receipt of this form. If you'd like to review those COVID-19 guidelines prior to submitting the form, you may email thevine@lincolnchristian.edu.) Earlybird registration ends on March 7.