Midwest 26 Below 2027 Registration
Complete this multi-page registration and review your details before submitting.
Participant Information
Participant Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age on Retreat Date
*
Chapel/Assembly
*
City
*
State
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
T-Shirt Size
*
Please Select
XS
S
M
L
XL
2XL
3XL
Minor Guardian Information
Parent/Guardian Name
*
First Name
Last Name
Relationship to Participant
*
Please Select
Parent
Legal Guardian
Step-Parent
Foster Parent
Other
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Health and Emergency
Does the participant have any food allergies or dietary restrictions?
*
Yes
No
Please describe the food allergies or dietary restrictions
Does the participant have any medical conditions we should know about?
*
Yes
No
Please describe the medical conditions and any instructions
Emergency contact name
*
First Name
Last Name
Emergency contact relationship
*
Emergency contact phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Lodging
Do you have a roommate request?
*
Yes
No
Requested roommate 1
First Name
Last Name
Requested roommate 2
First Name
Last Name
Requested roommate 3
First Name
Last Name
Requested roommate 4
First Name
Last Name
Lodging or accessibility needs
Chaperone / Youth Leader
How are you registering?
*
Please Select
Participant
Chaperone/Youth Leader
Are you attending with a chaperone or youth leader?
Yes
No
Name of your Chaperone/Youth Leader
*
First Name
Last Name
Youth Leader Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Youth Leader Email Address
*
example@example.com
Agreements and Signature
Permissions
*
I have read the information above. I agree to follow the rules set forth by CMML, Inc. and Hidden Acres Christian Center. I understand that I am responsible for myself and my transportation and do not hold CMML responsible for any injuries or illness incurred while on this retreat.
Permissions
*
My child has permission to attend with their youth group and will follow the rules set forth by CMML, Inc. and Hidden Acres Christian Center and do not hold CMML responsible for any injuries or illness incurred while on this retreat.
Media Release
*
I understand a photographer is present at all CMML conferences taking pictures for CMML publications.
Payment Agreement
*
I have read and agree to the registration fee and cancellation policy.
Payment
Payment option
*
Pay the full $109 now
My assembly will pay
Person Who Will Pay
*
First Name
Last Name
Person Who Will Pay Email
*
example@example.com
Person Who Will Pay Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
My Products
*
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Registration payment MW 26 Below
$109.00
$
109.00
Credit Card
Submit Registration
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