2022 Requesting CYIA Information

Request for Information

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Full Name *

First Name Middle Name Last Name
Current Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Cell Phone Number *

Area Code Phone Number
Email Address *
Age: *
If attending school, the name of the school you attend
The name of the church you attend *
How did you hear about the CEF Summer Ministry Program? *
Do you have any specific questions? *
What county do you live in? *
***CEF USE ONLY *** Local Chapter Name *
This field will automatically populate based on the county you select above.
Should be Empty:

Request for Information