Kick Back Registration

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Group Leader Name* This field is required.

3

Congregation* This field is required.

4

Church Address* This field is required.

Street Address

City

State / Province

Postal / Zip Code

Country

5

E-mail* This field is required.

example@example.com

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Phone Number* This field is required.

Area Code

Phone Number

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Please list all Youth* This field is required.(If you do know know the exact names and numbers attending, you are still encouraged to register for your spots. You can simply add the number of spots you would like to reserve. Example: Youth #1, Youth #2, etc.)

8

Please list all Adults* This field is required.

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Lodging* This field is required.

Cabin (Camp style - Bunk beds - bathrooms/showers in cabins)

Retreat Center (Hotel style - Bedding/Towels are provided) - $30 additional per person per night

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Does your group need transportation throughout the event, including airport pick-ups? ($60 per person)* This field is required.

Yes

No

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I will be paying my deposit by:* This field is required.

Check

Credit Card

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How many participants are you paying a deposit for?You can also use this paid to calculate your estimated total for the event.

My Bag

0

DepositPer person
$200.00+Edit
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Quantity
Subtotal: $0.00
Remaining Registration Fee after deposit
$410.00+Edit
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Retreat Center Lodging$30 per night person or $150 total for the week
$150.00+Edit
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Transportation$60 per person
$60.00+Edit
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If paying by check please mail to:

LRCC Office 39136 Harris Road, Oak Glen, CA 92399

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If paying by credit card submit this form and you will be redirected to our website where you can pay.

Be sure to remember your total generated on the previous page.

Your groups registrations is not final until a $200 deposit per participant is paid.