Register

The fee for the weekend is $45.00
Contact Rev. Rose Hassan for scholarship information.
*****Registration Deadline is December 30, 2009*****

A $25 deposit is required. An address to send a check to will be provided via email after you complete the registration form.

First Name (required)

Last Name (required)

Nickname or name you prefer to be called

Your Email (required)

Street Address (required)

City (required)

State (required)

Zip Code (required)

Home Phone (required)

Cell Phone

Work Phone

Home Parish [Name & City] (required)

Other Info

Please list any dietary requirements [Food allergies, vegetarians, etc]

Please list any medications you are currently on [information will be confidential]

Emergency Contact [Name, Number, & Relationship] (required)

Non Emergency Contact (required)

Birthday (required)
,

T-Shirt Size (required)
 S M L XL XXL

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