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NCYC Chaperone Registration

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  Chaperone Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parish REQUIRED Please fill out this field.
  
  I am registering for: Conference with hotel option (4 person room) Conference with hotel option (2 person room; additional cost) Conference with commuter option. I understand I am responsible for transportation.
  
  Agreement
  
  I understand a non-refundable deposit is required to hold my spot.
  I Agree Please select this field.
  
  I understand that I must be compliant with all diocesan Safe & Sacred requirements prior to attending NCYC.
  I Agree Please select this field.
  
  Today's Date REQUIRED Please fill out this field. Please enter a date.
  
  Payment
  
  Payment may be submitted via credit card, ACH, or by check.
  Checks should be written to St. Mary.
  
  Payment Method REQUIRED Credit Card ACH Submit a check to the Pastorate Office Please fill out this field.
  
  Chaperone Deposit100.0
  
  Total:
  
  Submit
  
  Pay Now
  
  Pay Later
  
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