UNPLUGGED Registration & Shirt Order
Please register your Youth Group below
Church Name & Youth Pastor
*
Church Name
Youth Pastor Name
Email
*
example@example.com
Youth Pastor Phone #
*
Format: (000) 000-0000.
Registration and T-Shirt Order
*
prev
next
( X )
Total Attending Unplugged
This is your ticket which includes lodging, T-Shirt, & food. Leader(s) also need to register
$180.00
$
180.00
Quantity
Unplugged T-Shirt XS
Free
$
Free
Quantity
Size
XS
Unplugged T-Shirt S
Free
$
Free
Quantity
Size
S
Unplugged T-Shirt M
Free
$
Free
Quantity
Size
M
Unplugged T-Shirt L
Free
$
Free
Quantity
Size
L
Unplugged T-Shirt XL
Free
$
Free
Quantity
Size
XL
Unplugged T-Shirt XXL
Free
$
Free
Quantity
Size
XXL
Unplugged T-Shirt XXXL
Free
$
Free
Quantity
Size
XXXL
Total Male Students
*
Total Female Students
*
Total Male Leaders
*
Total Female Leaders
*
How will you be making payment? Invoice will be emailed following submission
*
Check (make checks payable to Valley Church. Mail to 8100 Angel Ln Roanoke VA 24019)
Card (surcharge will be added)
Order Now
Should be Empty: