Michiana Youth Ministries Registraion Form
               

Registration for L.O.G. 33 November 21-23, 2008 at Camp Ray Bird, west of South Bend

The cost of the weekend is $80.00.
Early bird discount is $60.00 if payment is received by October 21

   
               
   Information about you        
First Name
Last Name
Nickname
(name you wish to be called)    
               
Street address
City
State
Zip
               
Home phone
E-mail
Cell phone
IM screen name
               
Birth Date
 mm/dd/yy    
School
Grade
 (If summer, last year's grade)
               
Church
 (If applicable)
               
Who invited you or
how did you hear about our program?
Have you ever attended a weekend like this before?
 (Cursillo, Chrysalis, Awakening,
Deco-Tec, Happening etc)
               
Why would you like to attend this MYM-sponsored program?
 

Tell us a little bit about your relationship with God.
 
               
We can occasionally offer a further small discount on the registration fee to those who are unable to afford the regular price.  Please indicate here if you need one in order to attend this event.    
               
We can only accept a certain number of people for each weekend.
Priority is usually given to students in 10th, 11th and 12th grades.
If accepted, you will receive a letter in the mail confirming the date and place of your L.O.G. weekend.