Guest Registration

Night to Remember 2019 Guest Registration is Now Open!
Sunday, October 6th from 5:00 PM to 8:00 PM

John Knox Pavilion located at 520 NW Murray Rd, Lee’s Summit, MO 64081

Welcome to registration. We are excited that you will be joining us for an evening filled with fun!
Please complete the entire form so that we can make sure you have a wonderful time.

Please note that you must be 15 years or older to attend.

Guest Registration 2019 October

Confirmation Email Address

Guest Information

Address Information
Address 1
Address 2
City
State/Province
Zip/Postal
You Must Provide at Least One Phone Number
If Different than Home Phone
You Must Provide at Least One Email Address

Caregiver Information

Parent / Guardian Information

Address Information
Street Address 1
Street Address 2
City
State/Province
Zip/Postal

Second Parent Information (If Applicable)

Address Information
City
State/Province
Zip/Postal