Registration Application
One application per registrant
Name
*
First Name
Last Name
Address - Street Address
*
Street Address Line 2
City
State / Province
Postal / Zip Code
City
*
Street Address
Street Address Line 2
State / Province
Postal / Zip Code
State/Province
*
Street Address
Street Address Line 2
City
Postal / Zip Code
Postal / Zip Code
*
Street Address
Street Address Line 2
City
State / Province
Contact Phone Number
*
Please enter a valid phone number.
Church that you attend:
Email
*
example@example.com
Check your choice of weekend:
*
October 4-6
October 11-13
Could you attend the other weekend if your choice is full?
*
Yes
No
Lodging Options
*
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next
( X )
Meadow Inn Room
Includes $8 transaction fee.
$
228
Cabin
Includes $8 transaction fee
$
178
Dorm
Includes $8 transaction fee.
$
178
Roommate's Name(s):
I need to be on the ground floor:
*
Yes
No
If you chose Meadow Inn Room, please select your second preference:
*
Cabin
Dorm
Emergency Contact:
*
Name
Emergency Contact Phone Number:
Please enter a valid phone number.
Submit
Should be Empty: