On-Line Registration

Fill out this form completely and submit it (preferred method) to Barry Joris.  You can also download the file in PDF form, print it and mail it to him (less desired method).

PLEASE READ!  This website uses Shared SSL.   SSL is the industry accepted method to secure web content between a client and the server. The content is encrypted and decrypted by the web server and the client's web browser. Shared SSL is a method that our Web Host Network provides that allows customers to use the web server's SSL certificate to facilitate the secure communication.  While this is the standard method of securing data, JBQFESTIVAL.ORG ands its operators can not guarantee the security of your data sent over this on-line registration.  If you are concerned about the security of your data, you have the option of printing out the registration form and faxing it to Barry Jorris.

Please note that we have had no issues with data security over the past three years that we have been using on-line registration.
PLEASE USE THE ON-LINE REGISTRATION FOR ALL REGISTRATIONS.  IF YOU ARE SENDING A CHECK PLEASE PRINT OFF THE REGISTRATION FORM AND SEND IT IN THE MAIL WITH YOUR CHECK.  THIS WILL BE VERY HELPFUL TO THE REGISTRATION PROCESS SO WE CAN KEEP EVERYTHING STRAIGHT.
Download Registration Packet (in PDF)


Use the tab key or your mouse to move from box to box.  Hitting "ENTER" will send the form!!

Mailing Address (Person to send confirmation to):
Name:
Street Address:
City:
State:
Zip Code:
Work Phone:
E-mail Confirmation To: *Required Field
 
Church Name:
Street Address:
City:
State:
Zip Code:
Coach:
Coaches Phone:
Credit Card Holders Phone:   *Required Field
Team Name:

Quizzer

 Age Master Seal Royal Rangers Missionettes
       

Officials Name's

  

Position

  
   
Name of District:
What place did you finish  in:
Name of your District coordinator:
Phone number of coordinator:
What Region did you compete in:
What place did you finish  in:
Name of your Regional coordinator:
Phone number of coordinator:
Bringing a Laptop for Scoring
# of Non-Participating Adults Coming
   
Please provide the following billing Information:
Credit Card:
Cardholder Name:
Card Number:
Expiration Date:

Submit this form electronically with credit card information for $100.00.  If paying with check, make the check payable to Junior Bible Quiz Festival and send to:

 Barry Jorris
First Assembly of God
1400 W Washington Center Road
Fort Wayne, IN 46825
 
**Please note that your registration can not be confirmed until payment is received.  If you submit this form without credit card number, your space will not held or confirmed until your check is received.