March 9-11


Cost is $195

A Non-refundable Pre-Registration of $100 is due by Feb. 5



Fill out the form and turn in payment to Pastor Dave by Feb. 5
(Make checks payable to Life Youth Ministry)

First Name:  
Last Name:  
Address:      
City:             State Zip
Phone Number 
Email Address  
Parents Name  
Date of birth     
School             
Grade  

T-Shirt Size   

I Need   

Roommate Preferences
(please list three)



PAYMENT
 I will give you my money at church
 Please take the money from my youth account
 I will pay online