Youth Event Registration Form

Complete the on-line registration form below

LOMT 2008 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

2008 Youth Events:*

Lifequest (May 2-4)

Fall Blast (Nov 21-23)

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:*

To contact the LOMT Registration Office:
Mailing Address: P.O. Box 457, La Grange, Texas 78945
E-mail Address: retreats@LOMT.com
Telephone: Local 979- 247- 4128
Long distance: 800-362-2078
Fax: 979-247-4120