Email Address	Confirm Email Address
* *	* *

First Name	Middle	Last Name	Suffix
*		*
Street Address (Line 1)
*
Street Address (Line 2, if applicable)
City		State	ZIP
*		-- AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AB BC MB NB NF NT NS NU ON PE QC SK YT *	*
Date of Birth (mm/dd/yyyy)		Gender
* *		Female Male *
Home Phone		Mobile Phone
*
Emergency Contact's Name		Emergency Contact's Phone
*		* *

How many previous Charlotte YAL Columbus Day Weekends have you attended?	How did you hear about this event?	(If other please specify)
* *	---Select Referral Source--- A friend or relative CarolinaGreeks.com Website/Email Charlotte YAL's Website DCGreeks.com Website/Email Facebook Flyer Local YAL Parish Priest Other (Please Specify) *
When are you arriving?	How are you getting here?	When are you leaving?
---Select--- 10/05/2012 10/06/2012 10/07/2012 *  ---Select--- Early Morning (12 AM - 6:00 AM) Morning (6 AM - 12 PM) Afternoon (12 PM - 6 PM) Evening (6 PM - 12 AM) 12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM *	---Select--- Flying Taking a Train Bussing Driving N/A (Local Attendee) *	---Select--- 10/05/2012 10/06/2012 10/07/2012 10/08/2012 * ---Select--- Early Morning (12 AM - 6:00 AM) Morning (6 AM - 12 PM) Afternoon (12 PM - 6 PM) Evening (6 PM - 12 AM) 12 AM 1 AM 2 AM 3 AM 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM * *

Will you need bussing to local events?	T-Shirt Size
---Select--- Yes No *	---Select--- Small (S) Medium (M) Large (L) Extra Large (XL) Extra Extra Large (XXL) *

LIABILITY WAIVER

I expressly acknowledge that I am holding harmless the organizers of Holy Trinity Greek Orthodox Church YAL (including but not limited to the Charlotte YAL Committee), their respective churches, their employees and agents, and DCGreeks.com, LLC, its employees, managers, owners and agents, and all their collective officers, directors, contractors, agents, employees, and volunteers, without regard to any negligence on their part, against any claim for injuries, damages, compensation or otherwise, including all losses and expenses, caused by or to me in registering for or participating in Charlotte YAL Columbus Day Weekend 2012 Convention.  I voluntarily assume the risk of injury, accident, death, loss, cost or damage to my person or property that might arise from my registration for and/or participation in Charlotte YAL Columbus Day Weekend 2012 Convention  or any related events.  My refusal to agree to the terms of this waiver will result in my exclusion from all events and my registration fees being refused or refunded.  I understand that my registration will not be accepted without this acknowledgement.

I acknowledge and agree to these terms. *

Notes:

Select Package:

Select One

Package Name

Events Included

Package Cost

A la Carte Events

Select	A la Carte Event	Cost	SubTotal
		Total A la Carte Event Cost:	$

Total Cost for this Registration: $ *

To help the organizers better plan for the events taking place during Charlotte YAL Columbus Day Weekend, please select all of the events which you are interested in attending. (Check all that apply)

10/5/12 Friday Greek Night at Phoenix with Disco Hristo & DJ Maraki 10/7/12 Sunday Greek Night at Dharma Lounge with DJ Mixalis & DJ Kosta X 10/6/12 Spiritual Discussion with Fr. Barnibas Powell 10/6/12 Saturday Afternoon Happy Hour at 5Church Restaurant (NEW) 10/6/12 Saturday Greek Night at Holy Trinity with Live Music by George Tsilimekis and Band 10/7/12 - Luncheon at Holy Trinity Greek Orthodox Cathedral (NEW) 10/7/12 Divine Liturgy at Holy Trinity

What would you like to do? *

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