FLY Registration I am registering for FLY as a * Student (12-18) – $749 Dorm Room Leader – $499 Staff – $499 Adult (19+) – $1049 Child (4-11) – $199 Child (0-3) – $0 Section High School Graduation Year * 2023 2024 2025 2026 2027 2028 2029 Due to limited seating capacity in the Longhouse, those registered as adults and/or children are expected to attend evening sessions in the overflow location in Assembly Hall. Students, Dorm Room Leaders, and youth workers are required to attend evening sessions in the Longhouse. Fly Staff Type FLY Committee Coordinator Manager Assistant By registering as this type of registrant, you acknowledge that you will be housed with either your spouse or an adult of the same gender. Individual rooms are not available. If you would like to stay in the dorms with students, you will need to register as a Dorm Room Leader instead. Who recruited you for this staff position? Coordinator/Manager who recruited you for this staff position? * – Photography Manager – Operator Manager Adam McCarlson – Elective Recording Manager Amy Swanson – First Aid Manager Andrew Abel – Longhouse Coordinator Andrew Kneeland – FLY Podcast Manager Ashley Blake – Social Network Coordinator Brett Boe – Spiritual Care Coordinator Britton Unverzagt – Recreation Manager Chris Rasmussen – Registration Coordinator Daniel Keinanen – FLY Podcast Coordinator Dave Ryerson – Late Hour Coordinator Diana Alverson – Woman's DRL Manager Emily Kregel – Articulate Manager Eric Christenson – Assembly Hall Manager Hallie Dutton – Social Network Manager Jason Holt – Concerns Manager Joel Lambrides – Intervention Resource Katie Johnson – Afternoon Coordinator Kirk Thorson – Evening Incident Manager Liz McCarlson – Office Coordinator Luke Edlund – Visuals Coordinator Luke Quanbeck – Production Manager Matthew Pillman – Day Incident Manager Michelle Olson – Adult Housing Manager Nate Crellin – Men's DRL Manager Nathan Monseth – Electives Manager Peter Pillman – Crisis Response Coordinator Phil & Kathy Bernards – FLY Squad Manager Randy Nelson – Altar Call Manager Rick & Penny Sullivan – FLY Store Coordinator Seth Moan – Music Coordinator Steph Inskeep – Housing Coordinator Susan Parsley – Speaker Coordinator Tasha Foss – On-Screen Manager Thom Jones – Network Manager Fly Staff Coordinator Position * Afternoon Coordinator Crisis Response Coordinator FLY Podcast Coordinator FLY Store Coordinator Housing Coordinator Late Hour Coordinator Longhouse Coordinator Music Coordinator Office Coordinator Registration Coordinator Social Network Coordinator Speaker Coordinator Spiritual Care Coordinator Visuals Coordinator Fly Staff Manager Position * Altar Call Manager Articulate Manager Assembly Hall Manager Concerns Manager Day Incident Manager Electives Recording Manager Electives Manager Evening Incident Manager First Aid Manager FLY Podcast Manager FLY Squad Manager Hospitality Manager Housing Manager Intervention Resource Men's DRL Manager Network Manager On-Screen Manager Operator Manager Photography Manager Podcast Manager Production Manager Recreation Manager Roamer Manager Social Network Manager Video Manager Woman's DRL Manager Fly Staff Assistant Position * Afternoon Altar Call Articulate Assembly Hall Branding Central Coffee House Conquering Challenges Convention Concerns Day Incident Dispatch Dorm Head Electives Evening Incident Evening Session FLY Podcast FLY Squad FLY Store First Aid Highlight Video Housing Late Hour Longhouse Music Network Office On-Screen Photography Prayer Production Recreation Registration Reusch Social Networking Speaker Spiritual Care Truck Driver Stories Video Visuals MUST BE PRE-APPROVED TO APPLY AS STAFF Responsibilities By applying, I affirm that I am committed to the following: I will be responsible to carry out my duties in this role. I will serve alongside staff in my area, and respect the leadership structure of the FLY Committee. I will lay aside personal preference to invest sacrificially in the position I am serving in. I will cheerfully comply with all FLY regulations, setting positive examples for students. I will respect the distinctives of Biblical Lutheranism as set forth by the AFLC. I will pray for students before, during, and for one week after the FLY Convention. T-Shirt Size * Small Medium Large Extra Large XX Large 3X Large 4X Large First Name * Last Name * Birth Date * Gender * Male Female Gender Dysphoria policy here Email * Cell Phone * By providing your cell phone number you are agreeing to receive FLY/Youth Ministry text messages Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona 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 State/Province Zip/Postal Zip/Postal Emergency Contact First Name * Last Name * Relationship * Parent Spouse Extended Family Close Friend Phone * Group Information Group Attending FLY * {Other} Abiding Faith Free & Elim Lutheran (Ortonville & Clinton, MN) Abiding Savior Free Lutheran Church (Sioux Falls, SD) Abiding Word Lutheran Church (Deshler, NE) Abiding Word Lutheran Church (Felch, MI) Above All Travel (Minneapolis, MN) Abundant Life Church (Thief River Falls, MN) AFLC Development (Plymouth, MN) AFLC Lutheran Ambassador (Plymouth, MN) AFLC President's Office (Plymouth, MN) Alida Lutheran Church (Bagley, MN) Alma Lutheran Church (Argyle, MN) Alsace Lutheran Church (Reading, PA) Amazing Grace Free Lutheran (Mitchell, SD) Ambassador Publications (Plymouth, MN) Amery Free Lutheran Church (Amery, WI) Andrew Abel (Richfield, MN) Association Retreat Center (Osceola, WI) Atonement Free Lutheran Church (Arlington, WA) Augustana Lutheran Church (Duluth, MN) Badger Creek Lutheran Church (Badger, MN) Bethany Free Lutheran Blue Grass (Sebeka, MN) Bethany Free Lutheran Church (Abercrombie, ND) Bethany Free Lutheran Church (Bemidji, MN) Bethany Lutheran Church (Astoria, OR) Bethany Lutheran Church (Binford, ND) Bethany Lutheran Church (Brodhead, WI) Bethany Lutheran Church (Viborg, SD) Bethel Community Church & Faith Free Lutheran Church (Culbertson & Brockton, MT) Bethel Free Lutheran Church (Grafton, ND) Bethel Free Lutheran Church (Minot, ND) Bethel Lutheran & Emmanuel Free Lutheran Church (Faith & Eagle Butte, SD) Bethlehem Lutheran Church (Monterey, CA) Bethlehem Lutheran Church (Morris, IL) BNY Production (Sioux City, IA) Buffalo Lake Lutheran Church (Sisseton, SD) Calvary Free Lutheran Church (Arlington, SD) Calvary Free Lutheran Church (Bismarck, ND) Calvary Free Lutheran Church (Eben Junction, MI) Calvary Free Lutheran Church (Fergus Falls, MN) Calvary Free Lutheran Church (Fosston, MN) Calvary Free Lutheran Church (Mesa, AZ) Calvary Lutheran Church (Everett, WA) Calvary Lutheran Church (Wallace, SD) Center Free Lutheran Church (Salem, SD) Chippewa Lutheran Church (Brandon, MN) Christ Community Church (Hagerstown, MD) Christ Free Lutheran Church (Devils Lake, ND) Christ Is Lord Lutheran Church (Onalaska, WI) Christ Lutheran Church (Shingleton, MI) Christ Lutheran Church (Stover, MO) Christ The King Free Lutheran Church (East Grand Forks, MN) Christ The King Lutheran Church (Pipestone, MN) Christ the King Lutheran Church (Wilson, WI) Christian Free Lutheran Church (Wheatland, IA) Community Lutheran Church (Oceanside, CA) Concordia University Irvine (Irvine, CA) Cornerstone Lutheran Church (Argyle, WI) Crellin Family (Fergus Falls, MN) Cross and Crown Lutheran Church (Montebello, CA) CrossRoads Christian Fellowship (Bastrop, TX) Crown Of Life Lutheran Church (Tomball, TX) Dalton Free Lutheran Parish (Dalton, MN) Dell Lutheran Church (Frost, MN) Dovre Free Lutheran Church (Winger, MN) Ebenezer Free Lutheran Church (Humboldt, TN) Ebenezer Lutheran Church (Northwood, ND) Edlund Family (Buffalo, MN) Egeland & Ortley Free Lutheran (Waubay & Ortley, SD) Elim Lutheran Church (Lake Stevens, WA) Elim Lutheran Church (Osakis, MN) Emmanuel Free & Beaver Creek Lutheran (Williston & Ray, ND) Emmanuel Lutheran Church of Aspelund (Kenyon, MN) Emmaus Lutheran Church (Bloomington, MN) Escanaba Free Lutheran Church (Escanaba, MI) Evangelism & Discipleship (Plymouth, MN) Faith Free Lutheran Church (Kalispell, MT) Faith Free Lutheran Church (Minneapolis, MN) Faith Lutheran Church (Blackduck, MN) Faith Lutheran Church (Durant, OK) Faith Lutheran Church (El Campo, TX) Faith Lutheran Church (Fairbury, NE) Faith Lutheran Church (Metropolis, IL) Faith Lutheran Church (Shakopee, MN) Faith Lutheran Church (Weslaco, TX) Faith Lutheran Church of Running Valley (Colfax, WI) Faith Lutheran of Mineral Point (Mineral Point, WI) FaithPoint Lutheran Church (New Prague, MN) First American & Hope Lutheran Church (Tripp & Delmont, SD) First English Lutheran Of Lostwood (Stanley, ND) First Lutheran Church (Ellendale, MN) First Lutheran Church (Oklahoma City, OK) FLBC (Plymouth, MN) FLBC Summer Teams (Plymouth, MN) FLY Committee (Plymouth, MN) Fox River Lutheran Church (Sheridan, IL) Free Lutheran Church of Roseau & Norland Free Lutheran (Roseau & Salol, MN) Free Lutheran Fellowship Church (Brownsville, TX) Freedom Lutheran Church (Ottawa, IL) Gloria Dei Lutheran Church (Saint Louis, MO) Good Shepherd Free Lutheran Church (Brainerd, MN) Good Shepherd Free Lutheran Church (Cokato, MN) Good Shepherd Free Lutheran Church (Madison, SD) Good Shepherd Lutheran Church (Camarillo, CA) Good Shepherd Lutheran Church (Lincoln, IL) Good Shepherd Lutheran Church (Pleasanton, TX) Good Shepherd Lutheran Church (Virginia, MN) Grace Evangelical Lutheran Church (Morris, IL) Grace Free Lutheran Church (Bagley, MN) Grace Free Lutheran Church (Dekalb, IL) Grace Free Lutheran Church (Maple Grove, MN) Grace Free Lutheran Church (Pelkie, MI) Grace Free Lutheran Church (Valley City, ND) Grace Lutheran Church (Bensenville, IL) Grace Lutheran Church (Bruce, SD) Green Lake Lutheran Church (Spicer, MN) Hauge Lutheran Church (Kenyon, MN) Hegland Free Lutheran Church (Strandquist, MN) Helmar Lutheran Church (Newark, IL) Holmes Ev Lutheran Church (Eagle Grove, IA) Home Missions (Plymouth, MN) Hope & Bethesda Lutheran (Northome & Mizpah, MN) Hope AFLC Church of Enderlin (Enderlin, ND) Hope Free Evangelical Lutheran Church (Ishpeming, MI) Hope Free Lutheran Church (Killdeer, ND) Hope Lutheran Church (Minneapolis, MN) Hosanna Free Lutheran Church (Saint James, MN) Immanuel & Trinity Lutheran Church (New Leipzig & Mott, ND) Immanuel Free Lutheran Church (Centerville, SD) Immanuel Lutheran Church (Springfield, MO) Inskeep Family (Andover, MN) Intervention Resource Team (Minneapolis, MN) Jones Family (St. Paul, MN) Joy Christian Community Church (Fountain Hills, AZ) Kelani O'Neil (Lena, WI) King Of Glory Lutheran Church (Shakopee, MN) Kroll Family (Ham Lake, MN) Landstad Lutheran Church (Shevlin, MN) Lisbon Bethlehem Ev Lutheran Church (Newark, IL) Living Faith Free Lutheran Church (Larimore, ND) Living Faith Lutheran Church (Boyertown, PA) Living Hope Church (Rogers, MN) Living Word & Zoar Lutheran Church (Edmore & Hampden, ND) Living Word Free Lutheran Church (Sioux Falls, SD) Living Word Lutheran Church (Eagan, MN) Lord of Life Lutheran Church (Mount Vernon, WA) Lord Of The Harvest Lutheran Church (Fairbank, IA) Lutheran Church Of Hope (Loveland, CO) Lutherans for Life (Nevada, IA) Maple Bay Free Lutheran Church (Mentor, MN) Maranatha Free Lutheran Church (Chassell, MI) Maranatha Free Lutheran Church (Glyndon, MN) Maranatha Free Lutheran Church of Ulen (Ulen, MN) Minnesota Valley Free Lutheran Church (Lakeville, MN) Minnewaska Lutheran Church (Starbuck, MN) Mission Lutheran Church (Swink, CO) Mountain View Church (Greeley, CO) Mt. Carmel Free & Trinity Lutheran Church (McIntosh, MN) Mt. Sion & Zion Lutheran Church (Kasson & Dexter, MN) Mt. Zion & Tressler Memorial Free Lutheran (Landisburg & Loysville, PA) National Artists (, ) New Hope Free Lutheran (Sisseton, SD) New Hope Free Lutheran Church (Jamestown, ND) New Luther Valley Lutheran Church (McVille, ND) Newark Lutheran Church (Newark, IL) North Prairie Free Lutheran Church (Churchs Ferry, ND) Ny Stavanger Free Lutheran Church (Buxton, ND) Oiland Lutheran Church (Badger, MN) Our Redeemer Lutheran Church (Kirkland, WA) Our Redeemer's Free Lutheran Church (Superior, WI) Our Savior's Free Lutheran Church (Mason, WI) Our Savior's Free Lutheran Church (Stanley, ND) Our Savior's Lutheran Church (Argyle, MN) Our Savior's Lutheran Church (Dillon, MT) Our Saviour's Ev. Lutheran Church (Cannon Falls, MN) Our Saviour's Lutheran Church (Dickinson, ND) Our Saviour's Lutheran Church (Patterson, CA) Our Saviour's Lutheran Church (Thief River Falls, MN) Our Saviour's Lutheran Church (Zumbrota, MN) Paradise Lutheran Church (Canfield, OH) Peace Free Lutheran Church (Canal Winchester, OH) Peace Lutheran Church (Saint Francis, KS) Pierson Family (Sioux Falls, SD) Prairie Faith Lutheran Church (Glenfield, ND) Prince Of Peace Lutheran Church (Beulah, ND) Pukwana Free Lutheran Church (Pukwana, SD) Redeemer Free Lutheran Church (Canton, SD) Redeemer Free Lutheran Church (Ontonagon, MI) Reformation Lutheran Church (El Cajon, CA) Reiner Lutheran Free Church (Goodridge, MN) Resurrection Free Lutheran Church (Beltrami, MN) Resurrection Lutheran (Carolina, Puerto Rico) Rice Lutheran Church (Bagley, MN) Rose Free Lutheran Church (Roseau, MN) Ruthfred Lutheran Church (Bethel Park, PA) Salem Free Lutheran Church (Freeman, SD) Salem Lutheran Church (Radcliffe, IA) Scandia Lutheran Church (Glenwood, MN) Shiloh Free Lutheran Church (Summerset, SD) Skrefsrud Lutheran Church (Beresford, SD) Slim Buttes Lutheran Church (Reva, SD) Solid Rock Free Lutheran Church (Anoka, MN) Spencer Creek Lutheran Church (Eugene, OR) Spruce Free Lutheran Church (Salol, MN) St. Ansgar's Lutheran Church (Salinas, CA) St. John's Free Lutheran Church (Duluth, MN) St. John's Lutheran Church (Finlayson, MN) St. John's Lutheran Church (Newark, OH) St. John's Lutheran Of Schwer (Milford, IL) St. John's of Lovi Evangelical Lutheran Church (Cranberry Township, PA) St. Mark's Lutheran Church (Whitestown, IN) St. Matthew Lutheran Church (Millerstown, PA) St. Olaf Lutheran Church (Chamberlain, SD) St. Olaf Lutheran Church (Montgomery, IL) St. Paul Lutheran Church of Dodge (Dodge, ND) St. Paul's Evangelical Free Lutheran Church (Hagerstown, MD) St. Paul's Evangelical Lutheran Church (Gifford, IL) St. Paul's Free Lutheran Church (Fargo, ND) St. Paul's Lutheran Church (Cloquet, MN) St. Paul's Lutheran Church (Jewell, IA) St. Paul's Lutheran Church (Marksville, LA) St. Peter Lutheran Church (Armour, SD) St. Peter Lutheran Church (Hawks, MI) St. Peter's Lutheran Church (Melvin, IL) St. Petrie Lutheran Church (Leland, IL) St. Stephen's Lutheran Church (Metropolis, IL) Stavanger Free Lutheran Church (Garden City, IA) Stillwater Free Lutheran Church (Kalispell, MT) Stronghold Lutheran Church (Trenton, MI) Sunburg Free Lutheran Church (Sunburg, MN) Sunnyside Free Lutheran Church (Stacy, MN) Tabor Lutheran Church (Webster, SD) Tamarack Lutheran Church (Tamarack, MN) Taylor Lutheran Church (Taylor, ND) The Source Church (Mesa, AZ) Timberland Ringebu Free Lutheran Church (Barronett, WI) Trinity Bergen & Lakeview Lutheran Church (Starkweather & Egeland, ND) Trinity Bethany Lutheran Church (Harvey, ND) Trinity Free Lutheran Church (Bemidji, MN) Trinity Free Lutheran Church (Grand Forks, ND) Trinity Free Lutheran Church (Janesville, WI) Trinity Free Lutheran Church (Minnewaukan, ND) Trinity Lutheran Church (Boscobel, WI) Trinity Lutheran Church (Brookings, OR) Trinity Lutheran Church (San Pedro, CA) Trinity Lutheran Parish (Golden Valley, ND) Trinity San Antonio Church (San Antonio, TX) Triumph Evangelical Lutheran Church (Nogales, AZ) Triumph Lutheran Church (Ferndale, WA) Trondhjem Lutheran Church (Volin, SD) True Vine Lutheran Church (Mora, MN) United Free Lutheran Church (Greenbush, MN) United Lutheran Church (Laurel, NE) United Lutheran Church (Manteca, CA) Valley Free Lutheran Church (Portland, ND) Victory Free Lutheran Church (Park River, ND) Vision Of Glory Lutheran Church (Plymouth, MN) Waikiki Beach Gathering (Honolulu, HI) Wannaska Lutheran Parish (Wannaska, MN) West Prairie Free Lutheran Church (Leonard, ND) Westaker Free Lutheran Church (Newfolden, MN) WMF (Plymouth, MN) Word Of Life Free Lutheran Church (Mankato, MN) Word Of Life Free Lutheran Church (Upsala, MN) Word Of Truth Lutheran Church (Kopperl, TX) World Missions (Plymouth, MN) Zion Free Lutheran Church (Wadena, MN) Zion Lutheran Church (Ashkum, IL) Zion Lutheran Church (Silverhill, AL) Zion Lutheran Church (Tioga, ND) Zion Lutheran Church Green Tsp (Valley City, ND) zz-chad-test (La Crosse, WI) Other Group Information Group Name * Group Address Group Address Group Address Group Address City City State/Province Alabama Alaska Arkansas Arizona 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 State/Province Zip/Postal Zip/Postal Group Leader Group Leader First Name * Group Leader Last Name * Group Leader Email * Cell Phone Update Update Group Leader Info Check this if you changed the group leader information that was automatically populated after selecting a group and you want us to update it for all attendees in this group. Pastor Information Pastor First Name * Pastor Last Name * Pastor Email * Image Release I/We understand that by registering for the FLY Convention, the registrant may have photos or video taken of them. I release and understand that those pictures and video may be used in various ways, which include social media posts during the week of FLY, videos shown at FLY, and FLY Convention promotional videos in future use. I/We understand that no reference to my child’s name would be made alongside such images. If you do not give your release, please click “no.” By clicking no, you understand that as pictures and videos are taken, it is challenging for our staff to know who you are, and henceforth agree to not put yourself in situations where pictures and videos are taken. Image Release: * Yes No Medical Release Parent/Guardian Name * Phone * I herein authorize the adult sponsors of the Free Lutheran Youth Convention to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care, to be rendered to the minor under the state of treatment, when the need for such treatment is immediate and when efforts to contact me (us) are unsuccessful. This includes the administration of Benadryl, Tylenol, or Ibuprofen if needed as perceived by the First Aid team. By checking this box you are agreeing to the conditions above, are legally responsible for the minor and are affixing your digital approval to this agreement. Medical Release Agreement * I Agree Health Insurance Do you have health insurance? * Yes No Health Insurance Info *Note that in order for this registration to be complete, if you have medical insurance, the insurance card must be uploaded at this time. We do not accept mailed or emailed insurance cards. Health Insurance Card (Front) * Drop a file here or click to upload Choose File Maximum upload size: 10.49MB Health Insurance Card (Back) * Drop a file here or click to upload Choose File Maximum upload size: 10.49MB Insurance Company * Plan/Policy # * Health Information Family Physician Family Physician Phone Allergies (Medical/Environmental) Health Problems Medications (If needed, a student’s Dorm Room Leader will be responsible for seeing that medications are taken. This cannot be the responsibility of the First Aid Team.) (Adults will be responsible for the medication schedule of children under 11 attending FLY. This field is for our first aid team in the instance of emergency.) Background Check You will not be approved to serve at FLY until the background check has been completed. You will be contacted via email by our background check company, Trusted Employees. The notification will be issued by email and the link provided will be active for 7 days. Contact AFLC Youth Ministries (763.545.5631) if you find that your background check link from Trusted Employees has expired. FLY will process background checks through Trusted Employees after each FLY registration deadline, so you can watch for your secure email inquiry after the following registration deadline passes. In considering you (“the consumer”) for employment including volunteer service and, if you are employed as a volunteer, in considering you for subsequent assignment, reassignment, promotion, retention, discipline, or other purposes, the FLY Convention (“the Company”) may request, obtain, and rely upon one or more consumer reportsA “consumer report” is a written, oral or other communication of any information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in making an employment-related decision about you. Such information may include, credit history information, criminal history information, driving records, verifications of your employment and/or education history; and other types of background information. or investigative consumer reportsAn “investigative consumer report” is a consumer report in which information on your character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with your prior employers, neighbors, friends, or associates, or with others who may have knowledge concerning any such items of information. In the event an investigative consumer report is requested about you, you are entitled to additional disclosures regarding the nature and scope of the investigation requested. The most common form of investigative consumer report is an inquiry into your employment and/or education history. about you from a consumer reporting agency. The federal governmental notice (“A Summary of Your Rights Under the Fair Credit Reporting Act”) has been provided to you to read and review. Signature (Type Full Name) * Your online signature above grants permission to the FLY Convention (“the company”) to conduct this background check after the date this form is submitted.Today’s date will be assigned with the time stamp date received from the completed FLY registration as the date of your signature approval. Optional for California, Minnesota, and Oklahoma Applicants Only: Mail Report Please check this box if you would like a free copy of the consumer or investigative consumer report prepared on you? Email Report Check this box if you would like your copy sent via email for faster delivery. If you indicated email delivery, then the report copy will be delivered to the email with which you have registered for FLY. References Please list two character references, including City, State, and Phone Number Reference 1: First and Last Name * City & State * Phone * Reference 2: First and Last Name * City & State * Phone * Education High School (and City/State) * Colleges attended Personal Experience Please answer the following questions. 1. Please share your personal testimony of faith in Christ. * 2. Please describe your personal devotional/quiet time life. * 3. Please relate your experience with Christian discipleship. * 4. Are you willing to be responsible during FLY, both for your own actions and the campers under your supervision? * Yes 5. Please explain anything that may show up on a background check. * 6. Are you interested in being involved with the Altar Call team, for students who respond at the Evening Service? * Yes No 7. We are hoping to create a new role at FLY 2023. A dorm shepherd/shepherdess will be stationed in each dorm to be available to provide soul care to students. Would you be interested in receiving training and possibly serving as a dorm shepherd/shepherdess? * Yes No 8. The FLY Committee does not expect every dorm room leader to handle every situation on their own. Conquering Challenges provides staff at FLY to work with areas of a difficult or sensitive nature. These areas may include, but are not limited to drugs and alcohol, crisis pregnancy / abortion, suicide/self harm (i.e. cutting, etc), sexual immorality (including homosexual behavior / temptation), victims of physical or sexual abuse, eating disorders. An important part of being a dorm room leader is being willing to partner with these trained staff members. In each of these, do you agree to refer the students in your care to a Conquering Challenges team member? * Yes No I will not refer students to a Conquering Challenges team member because… * Payment Information Payment Method * Credit Card Check by Mail Payment Options * Deposit – $150 Full Payment Coupon Code Registration Cost $ Discount Amount $ Pay 2.5% Credit Card Processing Fee No Yes I’d like to cover the fees associated with credit card payments to help fund future FLY Conventions. Credit Card Processing Fee $ Balance Due Later $ Amount Due Now $ Credit Card Information Credit Card * First Name * Last Name * Billing Address * Billing Address Billing Address Billing Address City City State/Province Alabama Alaska Arkansas Arizona 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 State/Province Zip/Postal Zip/Postal Check By Mail Please make checks out to FLY Convention Mail checks to: FLY Convention 3110 E. Medicine Lake Blvd Plymouth, MN 55441 All deposits and registrations are non-refundable and non-transferable. Checks must be postmarked by the current posted deadline in order to secure the registration rate. See registration deadlines here. Payment at Registration Check Payer at Registration Check # at Registration This check # is for the deposit/full payment made at registration. The amount of this check is already taken into account with the “Amount Due Now” above. Check Amount Received at Registration $ The amount due now when they register. Credit Card Amount Received at Registration Payments After Registration Payment Method Check Credit Card Payer Check / Invoice # Amount Recieved $ Add Remove Payment After Registration (Cont.) Total Payments After Registration $ Total Amount Due $ Old Payment Fields Check Payer after Registration Stripe Invoice # This is the invoice # generated by Stripe when an invoice was sent to receive a credit card payment after registration. The amount should be entered in the “Stripe/Check Amount Received” below. Check # after Registration Received This check # is for a payment made after registeration. The amount should be entered in the “Stripe/Check Amount Received” below. Stripe/Check Amount Received $ Housing YMCA Room # 0 2112 2114 2116 2118 2120 2122 2124 2128 2130 2132 2134 2136 2138 2140 2142 2203 2204 2205 2206 2207 2208 2209 2210 2211 2212 2213 2214 2215 2216 2217 2218 2219 2220 2221 2222 2223 2224 2225 2227 2228 2229 2230 2231 2232 2233 2234 2235 2236 2237 2238 2239 2240 2241 2242 2243 2245 2300 2301 2302 2303 2304 2305 2306 2307 2308 2309 2310 2311 2312 2313 2314 2315 2316 2317 2318 2319 2320 2321 2322 2323 2324 2325 2327 2328 2329 2330 2331 2332 2333 2334 2335 2336 2337 2338 2339 2340 2341 2342 2343 2345 5101 5102 5103 5104 5105 5106 5107 5108 5109 5110 5111 5112 5201 5202 5203 5204 5205 5206 5207 5208 5209 5210 5211 5212 5301 5302 5303 5304 5305 5306 5307 5308 5309 5310 5311 5312 5401 5402 5403 5404 5405 5406 5407 5408 5409 5410 5411 5412 6101 6102 6103 6104 6105 6106 6107 6108 6109 6131 6132 6133 6134 6135 6136 6137 6138 6139 6161 6162 6163 6164 6165 6166 6167 6168 6169 6201 6202 6203 6204 6205 6206 6208 6209 6210 6211 6212 6213 6214 6215 6216 6217 6218 6219 6220 6221 6231 6232 6233 6234 6235 6236 6238 6239 6240 6241 6242 6243 6244 6245 6246 6247 6248 6249 6250 6251 6261 6262 6263 6264 6265 6266 6268 6269 6270 6271 6272 6273 6274 6275 6276 6277 6278 6279 6280 6281 6301 6302 6303 6304 6305 6306 6307 6308 6309 6310 6311 6312 6313 6314 6315 6316 6317 6318 6319 6320 6321 6322 6331 6332 6333 6334 6335 6336 6337 6338 6339 6340 6341 6342 6343 6344 6345 6346 6347 6348 6349 6350 6351 6352 6361 6362 6363 6364 6365 6366 6367 6368 6369 6370 6371 6372 6373 6374 6375 6376 6377 6378 6379 6380 6381 6382 6401 6402 6403 6404 6405 6406 6407 6408 6409 6410 6411 6412 6413 6414 6415 6416 6417 6418 6419 6420 6421 6422 6501 6502 6503 6504 6505 6506 6507 6508 6509 6510 6511 6512 6513 6514 6515 6516 6517 6518 6519 6520 6521 6522 6523 6524 6525 6526 6527 6528 8101 8102 8103 8104 8105 8106 8107 8108 8109 8110 8111 8112 8113 8114 8115 8116 8117 8118 8119 8120 8151 8152 8153 8154 8155 8156 8157 8158 8159 8160 8161 8162 8163 8164 8201 8202 8203 8204 8205 8206 8207 8208 8209 8210 8211 8212 8213 8214 8215 8216 8217 8218 8219 8220 8221 8222 8223 8224 8225 8226 8227 8228 8229 8230 8231 8232 8233 8234 8235 8236 8237 8238 8239 8240 8251 8252 8253 8254 8255 8256 8257 8258 8259 8260 8261 8262 8263 8264 8265 8266 8267 8268 8269 8270 8271 8272 8273 8274 8301 8302 8303 8304 8305 8306 8307 8308 8309 8310 8311 8312 8313 8314 8315 8316 8317 8318 8319 8320 8321 8322 8323 8324 8325 8326 8327 8328 8329 8330 8331 8332 8333 8334 8335 8336 8337 8338 8339 8340 8351 8352 8353 8354 8355 8356 8357 8358 8359 8360 8361 8362 8363 8364 8365 8366 8367 8368 8369 8370 8371 8372 8373 8374 8501 8502 8503 8504 8505 8506 8507 8508 8509 8510 8511 8512 8513 8514 8515 8516 8517 8518 8519 8520 8601 8602 8603 8604 8605 8606 8607 8608 8609 8610 8611 8612 8613 8614 8615 8616 8617 8618 8619 8620 Lodge Name Status DRL Confirmation Letter Sent Check-In Status Not Checked-In Checked-In Sent Home Medical Emergency Out with Group If you are human, leave this field blank. Submit