CYIA of NC 2025 Retreat

CYIA of NC 2025 Retreat

Please complete this form to register for the CYIA of NC 2025 Retreat
Name*

First NameLast Name
Birthday

MonthDayYear
Date
Gender*

MaleFemale
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Chapter*
Allergies
Please list any dietary restrictions or relevant allergies
Forms

Parents: Please print, fill out, and sign the medical and permission form below. These forms should be brought to the retreat and turned in at the sign in table upon arrival.

If you have trouble downloading the documents, please email hope@cefwesternpiedmont.com to have them sent to your email.
Should be Empty: