SWFLJ Event Registration

First Name (each adult 18+ needs to fill out their own form)(Required)

Last Name (each adult 18+ needs to fill out their own form)(Required)

Telephone(Required)

Email Address(Required)

Hidden

Telephone

Are you a member or a guest?(Required)

Member

Guest

FIRST AND LAST NAMES of Minors Under the Age of 18 That Will Be Attending with You (If none, leave blank)

Have you experienced a fever of 100.4 degrees F or greater, a new cough, a new loss of taste or smell, or shortness of breath within the past 10 days? *(Required)

Yes (Please refrain attending service)

No (Go to the next question)

In the past 10 days, have you gotten a positive result from a COVID-19 test that tested saliva or used a nose or throat swab? (not a blood test)(Required)

Yes (Please refrain attending service)

No (Go to the next question)

To the best of your knowledge, in the past 14 days, have you been in close contact (within 6 feet for at least 10 minutes) with anyone while they had COVID-19?(Required)

Yes (Please refrain attending service)

No (Go to the next question)

Within the last 14 days, have you traveled to any U.S. state or territory beyond the immediate region? (If yes, you should quarantine for 14 days).(Required)

Yes (Please refrain attending service)

No (Go to the next question)

Have you been fully vaccinated? (This question does not disqualify you from attending or registering for service. Answering this question is voluntary).

Yes

No

Please select the services you will attend.(Required)

8:00 p.m. doors open at 7:30 p.m.

I understand by completing this registration, I consent for myself and/or other family members being on video and photograph during this taping. Any images obtained will be broadcast via multiple streaming outlets for public viewing.(Required)

Yes

SWFLJ Event Registration

Southwestern Florida Jurisdiction COGIC 2.0 Creating the A.W.E.

Remaining number of seats 258