CYIA of NC 2026 Retreat

CYIA of NC 2026 Retreat

Please complete this form to register for the CYIA of NC 2026 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 forms below. These forms should be turned in to your local director along with a copy of the student's insurance card before leaving for the retreat.

If you have trouble downloading the documents, please email hope@cefwesternpiedmont.com to have them sent to your email.
Medical Form: Please print and fill out
Parent Permission Form: Please print and fill out
Should be Empty: