Michiana Youth Ministries Registraion Form
Snow C.A.S.T.L.E. - January 23-25, 2009 -- Camp Ray Bird
               

The cost of the weekend is $80.00. Early bird discount is $60.00 if registration and payment are received by December 23, 2008.

Everyone - please print out and return a new medical form for 2008.

  
               
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?
               
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.