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2026 Ezemiah US Conference
December 26-30, 2025 @ Forest Home Creekside Camp, California, USA
10
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1
Student Information #1
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This field is required.
첫번째 참가자의 정보를 아래에 기입하여 주시기 바랍니다.
Name 이름 (First Name / Last Name)
E-mail 이메일 주소
Phone Number 핸드폰 xxx-xxx-xxxx
Birth Date 생년월일 (MM-DD-YYYY)
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Male 남자
Female 여자
Please Select
Please Select
Male 남자
Female 여자
Sex 성별
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Post College
College
High School (9,10,11,12th)
Middle School (6,7,8th)
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Please Select
Post College
College
High School (9,10,11,12th)
Middle School (6,7,8th)
Current School
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XX-Large
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Please Select
Small
Medium
Large
X-Large
XX-Large
Sweatshirt (Hoodie) Size
No, First Time
Ezemiah US
Ezemiah Korea Summit
Ezemiah Africa
Ezemiah Southeast Asia
Ezemiah Mexico
Ezemiah South America
Ezemiah UK or Europe
Ezemiah Middle East
No, First Time
Ezemiah US
Ezemiah Korea Summit
Ezemiah Africa
Ezemiah Southeast Asia
Ezemiah Mexico
Ezemiah South America
Ezemiah UK or Europe
Ezemiah Middle East
Prev. Experience in Ezemiah Movement
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2
Awesome picture of yourself
*
This field is required.
멋진 자신의 얼굴을 올려주세요
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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3
Student Information #2
Skip it if not necessary, 두 번째 참가자의 정보를 아래에 기입하여 주시기 바랍니다.
Name 이름 (First Name / Last Name)
E-mail 이메일 주소
Phone Number 핸드폰 xxx-xxx-xxxx
Birth Date 생년월일 (MM-DD-YYYY)
Please Select
Male 남자
Female 여자
Please Select
Please Select
Male 남자
Female 여자
Sex 성별
Please Select
Post College
College
High School (9,10,11,12th)
Middle School (6,7,8th)
Please Select
Please Select
Post College
College
High School (9,10,11,12th)
Middle School (6,7,8th)
Current School
Please Select
Small
Medium
Large
X-Large
XX-Large
Please Select
Please Select
Small
Medium
Large
X-Large
XX-Large
Sweatshirt (Hoodie) Size
No, First Time
Ezemiah US
Ezemiah Korea Summit
Ezemiah Africa
Ezemiah Southeast Asia
Ezemiah Mexico
Ezemiah South America
Ezemiah UK or Europe
Ezemiah Middle East
No, First Time
Ezemiah US
Ezemiah Korea Summit
Ezemiah Africa
Ezemiah Southeast Asia
Ezemiah Mexico
Ezemiah South America
Ezemiah UK or Europe
Ezemiah Middle East
Prev. Experience in Ezemiah Movement
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Next
Submit
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Enter
4
Awesome picture of yourself
멋진 자신의 얼굴을 올려주세요
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
Cancel
of
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Submit
Press
Enter
5
Student Information #3
Skit it if not necessary, 세 번째 참가자의 정보를 아래에 기입하여 주시기 바랍니다.
Name 이름 (First Name / Last Name)
E-mail 이메일 주소
Phone Number 핸드폰 xxx-xxx-xxxx
Birth Date 생년월일 (MM-DD-YYYY)
Please Select
Male 남자
Female 여자
Please Select
Please Select
Male 남자
Female 여자
Sex 성별
Please Select
Post College
College
High School (9,10,11,12th)
Middle School (6,7,8th)
Please Select
Please Select
Post College
College
High School (9,10,11,12th)
Middle School (6,7,8th)
Current School
Please Select
Small
Medium
Large
X-Large
XX-Large
Please Select
Please Select
Small
Medium
Large
X-Large
XX-Large
Sweatshirt (Hoodie) Size
No, First Time
Ezemiah US
Ezemiah Korea Summit
Ezemiah Africa
Ezemiah Southeast Asia
Ezemiah Mexico
Ezemiah South America
Ezemiah UK or Europe
Ezemiah Middle East
No, First Time
Ezemiah US
Ezemiah Korea Summit
Ezemiah Africa
Ezemiah Southeast Asia
Ezemiah Mexico
Ezemiah South America
Ezemiah UK or Europe
Ezemiah Middle East
Prev. Experience in Ezemiah Movement
Previous
Next
Submit
Press
Enter
6
Awesome picture of yourself
멋진 자신의 얼굴을 올려주세요
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
Cancel
of
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Submit
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Enter
7
Emergency Parents / Legal Guardian Contact Information 비상연락처
*
This field is required.
학부모 또는 법정 가디언의 이름과 전화번호를 기입해 주셔서 비상시 Authorization을 받을 수 있도록 해 주십시오. This person should be one who can give us legal authorization for us to respond over you/ or your child's emergency situation.
학부모 이름 Parents or legal guardian's name
Please enter Parents/Legal Guardian's mobile phone
Please enter Parents/Legal Guardian's email
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8
Rules and Expected Behavior
*
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Must Read and Agree the following
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9
Retreat Terms, Fee, Refund and Conditions
*
This field is required.
By signing this form, you are agreeing to the following terms: I agree to be an active participant in this event and to abide by the standards of behavior set forth by staff leaders. Early registration ends on November 23, 2025 and no refund will be allowed after December 1, 2025. I have read and understood the rules, procedures, and guidelines all covered in this form. 이 양식에 서명하는 것은 참가자(학생)가 컨퍼런스 스태프(사역자 및 교사)들이 정해 둔 일정한 행동규칙을 준수한다는 것과 온라인 양식에 명시된 가이드라인과 규율에 대해서 이해했고 동의한다는 것을 인정합니다. 2025년 11월 23일 이후에는 조기등록 혜택이 없으며, 2025년 12월 1일 이후에는 등록비 리펀드가 되지 않습니다.
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10
2026 Ezemiah US Conference Registration Fee
*
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No Refund after 12/1/2025***
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Great Product Name
$20
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Great Product Name
$20
Quantity:
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Size:
Small
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Great Product Name
$20
Quantity:
1
Size:
Small
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Great Product Name
$20
Quantity:
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Size:
Small
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ORDER SUMMARY
Total cost
USD
Early Registration by 11/23/25
No Refund after 12/1/2025
$
375.00
+
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Regular Registration
After 11/23/2025, No Refund after 12/1/2025
$
425.00
+
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First Name
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Credit Card Number
Security Code
Card Expiration
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