Winter Youth Retreat Online Registration Form

Winter Youth Retreat Registration Form

January 27-29, 2012

$90.00 per person

Please complete all fields of the form below to register for The Winter Youth Retreat.

Registering Youth Name:	First:
	Last:
	Age:
	Gender:	Female Male
ADDRESS:	Street:
	City:
	State:
	Zip Code:
E-MAIL ADDRESS
PARENT, GUARDIAN or EMERGENCY CONTACT	Phone:	Area Code: Number

Please Read:
Send Non-Refundable $90 reservattion cost to:
Winter Youth Retreat,
American Baptist Churches of WI
15330 Watertown Plank Rd.
Elm Grove, WI 53122-2391.
Please be certain to identify to which attendee the funds apply!

Now Either or the form.

on 11/12/2011