IYC 2026 GROUP FORM

This form is to be filled out by your Pastor or Youth Pastor only. $40 per person at the door.

Church
Pastor Pastor First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
Youth Pastor (if applicable) Youth Pastor (if applicable) First Last
Number of Students & Leaders
MORE THAN 20 PEOPLE TO REGISTER?

If the number of registration for your group is more than 20, please fill out another registration for the additional students that are not included on this current form that you are filling out.
List of Students + Leaders (First & Last Name)
PAYMENT INFO

By selecting submit, you will be redirected to the payment page. A 3.5% tax fee will be applied at check out for a debit / credit usage fee. Please note that by not finishing the payment, Impact Michigan will not receive the form and be able to count it as a full registration.