Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Country
University/Church
*
Please Select
UW-Eau Claire Chi Alpha
UW-Green Bay Chi Alpha
UW-La Crosse Chi Alpha
UW-Milwaukee Chi Alpha
UW-Oshkosh Chi Alpha
UW-River Falls Chi Alpha
UW-Stevens Point Chi Alpha
Michigan Tech U Chi Alpha
N. Michigan U Chi Alpha / Northiron Church
Eau Claire-Harvestime
Kenosha-Journey Church
Kimberly-Fox Valley Christian Fellowship
Madison-New Culture Church
Marshfield-North Ridge Church
Milwaukee-Embassy Center
New Berlin-Banner Church
Oak Creek-Discover Church
Plymouth-Christian Life Church
Racine Assembly of God
Sparta-New Life
Other
If Other, please tell us your church or school
Date of Birth
*
-
Month
-
Day
Year
Registration is only available for those 18-25 year old.
Sex
*
Male
Female
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Registration
Includes 2 nights lodging, 5 meals, and all sessions and activities.
$
125.00
Quantity
1
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