LOMT 2010 Youth Event Registration Form

All required fields are marked with an*
Church Name:*
Group Name:
Church Mailing Address:*
City:* State:* Zip:*
Church Phone:* ( ) - Church Fax: ( ) -
Adult Leader:*
Position:*
Day Phone:* ( )- Cell Phone: ( )-
E-Mail address:*

NOTE: If you do not have an e-mail, enter your first and last name in the e-mail field.

RETREAT PARTICIPANTS:
Total Number of Young People:* Male Female

Total Number of Adult Leaders:* Male Female

ALL GROUPS MUST HAVE AN ADULT LEADER ON SITE
PROVIDING SUPERVISION DURING THE ENTIRE EVENT

Youth Events:*

Lifequest (April 23-25)
Fall Blast Retreat (Nov 12-14)