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Register for Youth Escape 2018
Register one person at a time with this form. Those who register by June 26 will receive a Youth Escape T-shirt.
Registrations will be accepted until
July 10
.
Questions? Contact Shana at shanaboshart@centralplainsmc.org.
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Gender
*
female
male
Email
*
Home phone
*
Congregation
*
Your Contact Sponsor
*
The name of the sponsor who is the contact for your youth group.
I am a
*
youth
sponsor
volunteer staff
rep from another organization
If you are a rep, name your organization
*
Those who register by
June 26
will receive a Youth Escape 2018 T-shirt.
(Give us your size no matter when you register and we'll do the best we can.)
T-shirt size
*
S
M
L
XL
XXL
XXXL
Please list any medications you are taking or any allergies you have.
*
Any additional comments or instructions
*
Registration fee: $130 per person
The registration fee includes lodging for Friday and Saturday nights, three meals on Saturday and breakfast and lunch on Sunday. The cost is $130 until June 19; and $140 after June 19. Refunds may be given on a prorated basis between May 15 and June 26. No refunds after June 26.
Submit