Momentum'23 Integrity Principle Registrations

Momentum'23 Integrity Principle Registrations

Please complete the following form for all Integrity Principle Students. This information MUST be included for the Integrity Principle Scholarship to apply. Scholarships cannot be processed until received.
Youth Conference Coordinator*
First/Last Name
Email*

Confirmation Emailconfirm email address
Church City*
Church Name*
Please read the Momentum Group Agreement before registering Integrity Students to ensure that they meet the criteria for the Integrity Student Scholarship.
*

I acknowledge that I have read and understand the terms and agreements per the Momentum Group Agreement regarding Integrity Principle Scholarship eligibility.
Integrity Principle Student Name 1*

First NameLast Name
Name of Student bringing this person 1*

First NameLast Name
Integrity Student Address 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have additional Integrity Students?

YesNo
Integrity Principle Student Name 2

First NameLast Name
Name of Student bringing this person 2

First NameLast Name
Integrity Student Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have additional Integrity Students?

YesNo
Integrity Principle Student Name 3

First NameLast Name
Name of Student bringing this person 3

First NameLast Name
Integrity Student Address 3

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have additional Integrity Students?

YesNo
Integrity Principle Student Name 4

First NameLast Name
Name of Student bringing this person 4

First NameLast Name
Integrity Student Address 4

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have additional Integrity Students?

YesNo
Integrity Principle Student Name 5

First NameLast Name
Name of Student bringing this person 5

First NameLast Name
Integrity Student Address 5

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have additional Integrity Students?

YesNo
Integrity Principle Student Name 6

First NameLast Name
Name of Student bringing this person 6

First NameLast Name
Integrity Student Address 6

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have additional Integrity Students?

YesNo
Integrity Principle Student Name 7

First NameLast Name
Name of Student bringing this person 7

First NameLast Name
Integrity Student Address 7

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have additional Integrity Students?

YesNo
Integrity Principle Student Name 8

First NameLast Name
Name of Student bringing this person 8

First NameLast Name
Integrity Student Address 8

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please sign below confirming that the above students meet the Integrity Principle criteria. *

Clear
Please enter your Lead Pastor's Name and Email address below, as we will be confirming Integrity Students eligibilty with Lead Pastors as well. They can expect an email requesting confirmation of all Integrity Students submitted within their church.
Senior Pastor Name*

First NameLast Name
Senior Pastor Email*

Confirmation Emailconfirm email address
Please be sure to hit submit below. You will be directed to a Thank you page and receive a confirmation email. IF YOU DO NOT RECEIVE THIS, THEN YOUR SUBMISSION WAS NOT SUCCESSFUL. (please check your spam folder if you do not receive confirmation in your inbox)

For any questions contact:

ilsmonline@idcag.org or 217.854.4641
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