Location you wish to attendLakelandLakeside ChurchNew SmyrnaNorthland ChurchIs this your first time attending?* Yes No Name* First Last Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please list additional attendees CommentPLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION. I release Lift Disability Network, its staff, and volunteers, and the BOOST facility from all actions, damages, or personal injuries which may occur to me. I understand in the event of a minor injury I may receive first aid treatment. In the event of an emergency, injury, or illness, emergency medical services I will decide the best course of action. Signature* First Last Type full name for signature
