YE 2018 Reg Form

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 *

Email *

Home phone *

Congregation *

Your Contact Sponsor *

I am a *

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 *

Please list any medications you are taking or any allergies you have. *

Any additional comments or instructions *

Registration fee: $120 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 $120 by May 15; $130 from May 16 - June 19; and $140 after June 19. Refunds will be given on a prorated basis between May 15 and June 26. No refunds after June 26.

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