2024 Rockbridge Alum Springs Wk 8

WHERE: Rockbridge Alum Springs

WHEN: July 13-17, 2024

COST: $598

After completing this form, a confirmation will be sent with the information you have entered below.

Questions and Information

Contact at the Young Life Office at:

540-705-1547

[email protected]

Participant Information

Guest Type

Are you bringing a child?

Registration Options

Register with a deposit or full payment ($598.00)
Please select to make a deposit or full payment below. Your card will not be immediately charged.
Register without a deposit ($598.00)

Participant Name

Date of Birth

Phone

Phone Type

Participant Address

Gender

Male
Female

Ethnicity

Other Languages Spoken

T-shirt Size

High School Graduation Year

Additional Comments

Parent / Guardian Information

Fill out the following parent/guardian information for the participant you are registering above.

Parent/Guardian Name

Parent/Guardian Phone

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Phone Type

Parent/Guardian Email

Address is same as participant

Parent/Guardian Address

Would you like to cover the 2.5% credit card processing fee?

Total

$0.00

Billing Information

Name

Payment Method

Credit Card
Cash/Check

Credit Card

Visa
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American Express
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Address

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