Youth Rush Victoria 2024

First Name

Last Name

Email

Phone/Mobile

Age:

Address

Line 1

Line 2

City

State

Postal Code

Church you attend

What Youth Rush are interested in?

– Select –Yackandandah-Wangaratta July 2024Melbourne December 2024BothNot sure yet which date but keen

Are you a baptised member of the Seventh day Adventist church?

– Select –YesNo

Why would you like to attend this program?

Have you had any experience with canvassing/doorknocking? If so, tell us about this experience.

Dietary Requirements:

Recent Injuries/Illnesses:

Medicare Number:

Position on Card:

Date of Expiry:

Emergency Contact: (If you are under 18 years old.) Please provide guardian’s Full Name

Guardians Contact No:

If I suffer injury or illness while YOUTH RUSH Conference, the Literature Ministries or the organisation can arrange medical and emergency evacuation services as deemed necessary by the organisation, for my health and safety.

– Select –I agreeI don’t agree

While at the YOUTH RUSH Conference, I understand that photos and videos of those covered by this registration may be taken and that this event could be live-streamed. I also understand that the photos and video footage may subsequently be used in productions and promotions (including print, internet, social media and audio-visual presentations) by Literature Ministries and the Victorian Conference.

– Select –I agreeI don’t agree

I understand that my NAME, CONTACT NUMBER, MEDICARE, GENDER, CHURCH NAME and EMERGENCY CONTACT details will be collected and stored securely by Literature Ministries in Victorian Conference and will be held from the point of Registration until six months after the YOUTH RUSH Conference 2024. This data will only be used for the purposes of registration, contact and identification at the YOUTH RUSH and Literature Ministries in Conference and will not be shared with any third parties.

– Select –I agreeI don’t agree

NOTE

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