YMJA Youth Retreat - Midwest RetreatAll information requested must be provided in

order to process your registration.

Name

Address

City, State, Zip

Email Address

Date of Birth Phone

Congregation Congregational Leader

Registration Fees Received: Price: Before August 18, 2017 $159.00 After August 18, 2017 $189.00 YMJA ‘17 Membership Dues $10.00 Single (13-30 year olds only) $15.00 Married Couple

* Membership dues are required if not a current member.** Registration fees are the same for all retreat attendees including YoYouth Leader,Chaperones, and other leaders. Total:

Please make your check or money order payable to the YMJA.If you’d like to pay by credit card, you can register online at ymja.org

For those who are renewing their membership or becoming a member for the 1st time, please complete the bottom section.

Are one of your parents or grandparents Jewish? Yes No

Statement of Faith

I have made my public confession of faith in the Messiah Yeshua(Jesus). I have accepted Him personally as my Lord and my Savior.I believe in His Deity, His atonement for sin, and His resurrectionfrom the dead. I accept the scriptures (Old and New Covenants) asthe supreme rule of faith and life. In applying for Membership to theYoung Messianic Jewish Alliance, I affirm my adherence to the aboveStatement of Faith. I also affirm that all the information representedon this form is truthful and accurate to the best of my knowledge.

Signature Date

Please detatch and mail your registration with a check ormoney order to:

YMJA Retreat MW Phone: 679-609-8648P.O. Box 983 Email: hannah@ymja.orgRoswell, GA 30077 Website: www.ymja.org

Importatnt: Please see other side

P.O. Box 983Rosw

ell, GA 30077

WHEN IS THE RETREAT?Registration is open on Friday, September 15 from 6:00 to 8:00 PM. The retreat will end on Sunday, September 17 at 2:00 PM. Please eat dinner before arriving at registration on Friday evening.

WHO CAN ATTEND?Any young person between the ages of 13–21 years old. Youth Leaders and/or Chaperons are also invited to register.

WHERE IS THE RETREAT LOCATED?This year, our retreat will once again be located at Lake Placid Christian Conference Center in Hartford City, IN. The facility is known for its wonderful accommodations and beautifulscenery. Visit the camp’s website at www.lakeplacidindiana.org/ to take a virtual tour of the facilities. The retreat isconveniently located within 2-4 hours of major Midwestern cities such as Cincinnati, Indianapolis, Cleveland, and Grand Rapids. A map with detailed directions will be sent upon receipt of retreat registration.

HOW MUCH DOES IT COST?The cost for the entire weekend is just $159 for earlyregistration and $189 for late registration. In addition,attendees must pay a $10.00 membership fee if theyhave not yet paid their 2017 YMJA Membership Dues.

WHEN IS REGISTRATION DUE?Registration must be received by Friday, August 18.After August 18, there will be a $30 late fee to register, and you must call the YMJA office to make arrangements. Note: You can register and pay online at www.ymja.org or by mail!

WHERE WILL WE BE SLEEPING?We will be staying in cozy cabins at Lake Placid. There are separate accommodations for ladies and gentleman, and cabins will be chaperoned. Beds will be provided, but please make sure to bring your own linens including a sleeping bag or sheets and a pillow.

WHAT DOES THE REGISTRATION INCLUDE?Registration fees include housing, all activities, and all meals beginning with breakfast on Saturday morning.

Youth-Only RETREAT

HARTFORD CITY, INSEPTEMBER 15-17, 2017

MIDWEST

“I am the vine; you are the branches. The one who abides in Me, and I in him, bears much fruit;

for apart from Me, you can do nothing.” -John 15:5

Parent / Guardian Consent Form

I, give permission for my(son/daughter) toparticipate in the YMJA MW Youth-Only Retreat conducted onSept. 15, 2017 through Sept. 17, 2017 under the directionand authority of the Young Messianic Jewish Alliance. I affirm that my child is in good physical condition and has nothad any serious illnesses or operations since his/her last healthexamination.

Emergency Medical Authorization: I hereby authorize any adultleader of this retreat to act as my agent in fact, to approve anymedical or dental treatment for my child as required by emergency.I also authorize any adult leader of this retreat to take any correctiveaction that may be necessary in order to protect the emotional,social or physical welfare of my child. If the retreat leaders deem itnecessary to send my son/daughter home for any reawson,I understand it will be at my expense. I hereby agree to release, hold harmless and indemnify, the Young Messianic Jewish Alliance and the Messianic Jewish Allianceof America, including any staff, employees, administration, affiliates,volunteers and participants of any kind from any claims for damagesor money whatsoever arising out of the above referenced trip. I also understand that the following rules as stated below are tobe followed at all times.

1. The YMJA schedule/rules are to be followed at all times and deviation from that schedule will only be allowed per the Ministries Director’s permission. 2. At no time shall a teen be in a room belonging to the opposite sex. 3. Alcohol is strictly prohibited on the retreat property. Any violations of this rule will result in dismissal from the retreat at the violator’s expense and the banning of said violator from future YMJA conferences. 4. Illegal drugs of any kind are strictly prohibited and discovery of such will result in dismissal from the retreat at the violator’s expense and the banning of said violator from future YMJA conferences. Criminal action can be taken by the State of Indiana.

Parent/Legal Guardian Signature Date

Address

City State Zip

Telephone Number(s)

Insurance Carrier:

Name of Company Telephone Number

Policy number Agent

Please list any medications taken by the retreat participant:

ACTIVITIES INCLUDE:• Wolibogne!• Youth-led worship• Core Groups• Team Builders• Outdoor Sports & Activities• And More!

SESSIONS:> The Force> The Force in our Movement> Accepting the Force as You Are> The Force of Yeshua’s Life

If you are a youth leader interested in chaperoning, please email hannah@ymja.org The YMJA is a subsidiary of the and is a sister organization of the

Lake Placid Christian Conference CenterHartford City, IN

September 15-17, 2017

Come and join us for a weekend that will transform your life!

WEEKENDGUEST SPEAKER:Debbie Chernoff

Hey All! My name is Debbie Chernoff.I live in Philadelphia, PA, of Jim’scheesesteak fame! I have three (fairly) grown kids, one old cat, a brand new puppy (what was I thinking?!), and a husband named Rabbi David Chernoff, who many of you have probably met. I’m really excited about spending time with you all at this YMJA retreat. I’m praying for our weekend and for all of you to get a great spiritual, as well as social, boost as a result of us being together. We will dig into God’s Word, worship together (a passion of mine is to see the next generation of Messianic worshippers rise up!), pray together, and just hang out. Can’t wait to meet you!

Midwest RETREAT

Michigan

Indiana

Illinois

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Tennessee

Ohio