Full Name
*
First Name
Last Name
There are 2 ways to register; by phone or email. Please select.
*
phone
email
Phone Number
*
Email
*
example@example.com
Are you registering as an Individual or a Family?
*
Please Select
Individual
Family
How many adults in your family? (Ages 13 and Up. Please include yourself also)
*
How many children in your family? (Ages 12 and under)
*
Total in your family (Adults & Children combined)
*
How did you find out about this program?
*
Please Select
*I was invited by a member of Christ Embassy
*I was invited by someone who will be attending the program (not a member of Christ Embassy)
*I am a member of Christ Embassy / Church Announcements
*Facebook
*Instagram
*Flyer
*Other
Name of person who invited you
*
Prayer Request/Questions/Comments
Submit
Should be Empty: