2024 LATE/ON-SITE Summit Registration

Registration Information

College or University

If you do not see your college or university in the provided options, please email us at [email protected] PRIOR to completing registration

Registration Options

Student of College from within the Richmond Diocese ($50.00)
Student of College from outside the Richmond Diocese ($60.00)
Campus Ministry Staff of College from within the Richmond Diocese ($0.00)
Campus Ministry Staff of College from outside the Richmond Diocese ($0.00)

Personal Information

Name

First Name for Namebadge

Phone Number

Home Address

Sex

Date of Birth

T-Shirt Size

Emergency Contact Name

Emergency Contact Phone Number

Relationship to Participant

College or University Information

Expected Graduation Year

Were you invited by someone?

Transportation

I would prefer

Taking the bus
Driving myself
Driving there myself and taking the bus back
Taking the bus there and driving myself back

I would prefer

Using the shuttle
Driving myself

By checking this, I understand the travel arrangement I selected above is not guaranteed, due to registering after the deadline date*

Lodging

I would prefer

A hotel provided by the Richmond Diocese
No hotel

By checking this, I understand the sleeping arrangement I selected above is not guaranteed, due to registering after the deadline date*

Dietary

Dietary Restriction

Can you eat an original Chick Fil A sandwich without any modifications

By checking this, I understand my dietary restrictions cannot be guaranteed to be met due to registering after the deadline date*

Other Information

Please complete the information below so we may be aware of any specific concerns or accommodations that the staff should be aware of. All of this information is kept confidential and will not be shared.

Do you have any allergies?

Do you take prescription medication?

Do you have any emotional, physical, or sensory conditions we should be aware of?

Release of Liability & Medical Release

I agree on behalf of myself, my heirs, assigns, executors, and personal representatives, to hold harmless and defend the Catholic Diocese of Richmond, its officers, directors, agents employees, or representatives associated with this event from any and all liability, loss or damage arising from or in connection with my participation in this diocesan event.

Furthermore, I hereby warrant that to the best of my knowledge, I am in good health and assume all responsibility for my health. In the event of an emergency, I hereby give permission to transport me to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor or that my emergency contact be notified prior to any further treatment. I will not hold the Diocese of Richmond responsible for authorizing any medical treatment beyond necessary transportation to the hospital.

Electronic Signature

Date

Use of Pictures and/or Video

I give permission for pictures and/or video of me engaged in activities related any Diocesan event to have my pictures posted in the Diocese of Richmond publications or websites.

Use of pictures/videos

Electronic Signature

Date

Coupon Code

Billing Information

Name

Payment Method

Credit Card
Check

Credit Card

Visa
Mastercard
American Express
Discover

Address

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