Leaders Registration

Leaders & Sub-Leaders Registration

Please come join us for our 7th annual kids Retreat......

When: July 29th to Aug 1st, 2011
Location: Forest Home Ojai Valley
Registration fee:$160.00

adult_reg_medicalconsent_form3.pdf
File Size:	150 kb
File Type:	pdf

Download File

Register Here

Leader Or Sub-Leader? *

Leader Sub-Leader

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Confirm Email *

Gender *

Male Female

Adult T-Shirt Size *

Have you attended or served at the Kids Retreats in the past? *

Yes No

Name of the church you currently attend *

Emergency Contact Name *

Relationship *

Phone Number *

Email *

How did you hear about the retreat? *

Making a full payment? *

Yes No

Payment Options: *

Card Type: *

Name on the card: *

Card Number: *

Card expiration month: *

Card expiration year: *

cvv number on credit card: *

Billing Address (if different then above) *

Line 1

Line 2

City

State

Zip Code

Country

Any Comments, concerns, prayer request or praise? *

Payment by mail

Please remit your payment to:
AEC
C/O 2010 Kids Retreat registration
P.O Box 660896
Arcadia, CA 91006

Welcome to the Amazing Bible Adventure

Register Here

Payment by mail