Name

First Name

Last Name

Congregation

City, State

High Schoolers Attending

Middle Schoolers Attending

Adults and other Children

Payment

Erupt is $45 per person. Please add up all who are attending and type it in the box. Elders are free!

Thank you! Your registration is in our records. Remember you are not fully registered until we have received a check from you. Please mail all checks to Erupt Youth Rally 291 Ben La Dr. McMinnville, TN 37110

Registration