CI 2007

Individual Application Form

Registration Fee: (Board, lodging and materials)
$110.00 if recieved before November 25, 2007; Late registration: $125.00 no later than December 16
Make check payable to: Umphress Road UMC
 
Church:
Name:    Phone:   
Address:
City:    State:    Zip Code:
E-mail:     Age:
Gender:     Group:
If Youth: Current Grade in School:     Date of Birth:
If College/Post-High School*: Would you like to participate as a camper or a jr. counselor?
If Adult: Would you be willing to co-lead a small group? Yes No
Do you have physical limitations? Food preference? (if yes, please explain)
Workshop Choices (Choose 4)     1.    2.
                                                              3.    4.
Alternate Choices (Choose 2)    5.    6.
CI 2007 Workshops Here
T-Shirt Size:               Kids: L Adult: S M L XL XXL
*If you would like to be a junior counselor, please fill out the Background Check Form and the Junior Counselor Application Form and turn them in.