Winterfire Individual Registration

Individual Registration Form

JAN. 13-16 LAGUNA BEACH, FLORIDA Registration: $180 per person if you register by Dec. 1. $200 per person after Dec. 1st.
Are you a:

CounselorStudent
Student Name

First NameLast Name
Email
example@example.com
Phone
Please enter a valid phone number.
Parent/Guardian Name (if applicable)

First NameLast Name
Payment Details

In order to secure your spot, a $25 non-refundable deposit must be paid upon submission of registration. Remaining balance due by December 1st.
Reminders
Cancellation - Registration must be canceled by Dec. 15th.

Payment Method - If you would like to use another form of payment not listed below please contact us at: winterfirefl@gmail.com or - (937) 550-3291.
My Products
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Winterfire Paid In Full
$200.00

Total

$0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Individual Registration Form