Event Registration

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Middle School Summer Retreat on Saturday, July 20, 2024 @ 5:00 PM

Price:

299.00

*Attendee's First Name:

*Attendee's Last Name:

*Attendee's Email Address:

*Attendee's Phone Number:

Country:

Address Line 1:

Address Line 2:

City, State Zip:

*Gender :

*School Grade :

*School :

*Do you regularly attend church? :

If "yes" what church do you most regularly attend? :

Please fill out information for the student's primary guardian

*Guardian 1: First Name:

*Guardian 1: Last Name:

*Guardian 1: Phone Number:

*Guardian 1: Email:

*Guardian 1: Mailing Address:

*Guardian 1: City, State:

*Guardian 1: Zip:

Please fill out information for the student's secondary guardian (if applicable)

Guardian 2: First Name:

Guardian 2: Last Name:

Guardian 2: Phone:

Guardian 2: Email:

Guardian 2: Mailing Address:

Guardian 2: City, State:

Guardian 2: Zip:

If you are a retreat volunteer, enter your promo code here:

Promo Code:

Registration Total: