LOMT 2012 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:*

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 27-29)
Fall Blast Retreat (November 16-18)