LOMT 2012 Pre Confirmation 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:*

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
Pre Confirmation Session:*

Pre-Confirmation 1 (Sept 14-16)
Pre-Confirmation 2 Latham Springs (Sept 21-22)
Pre-Confirmation 3 (Oct 5-7)
Pre-Confirmation 4 (Oct 12-14)
Pre-Confirmation 5 (Oct 26-28)

Note: Pre-Confirmation 2 held at Latham Springs Camp near Waco is a one-night event

Length of Stay:

Deposit: A $25 per person, non-refundable, non-transferable deposit
is required to reserve space(s).
Total Number of people attending* X $25 = Total Deposit
Total Due:*