EMBOLDEN 2019 Registration

EMBOLDEN 2019 Registration

 

Click here for the FLYER!

Date: Friday, November 15 - Sunday, November 17
Time: 7pm Friday - 12pm Sunday (transportation times will be communicated by your Youth Minister)
Location: Camp Tecumseh in Pittstown, NJ
Who: All high school teens are welcome!
Cost: $185 (There is an added $25 late fee for those who register the week of the event, bringing it from $160 to $185)

Deadline: Friday, November 8th
After this registration deadline, there will be a late fee of $25 added to the cost of the retreat.


For questions, please contact Allison Provinsal at aprovinsal@fiatventures.com



Payment Option:


Participant Information

*First Name
*Last Name
*Address
Apartment If Applicable
*City
*State
*Zip Code
*Email
*Home Phone (XXX-XXX-XXXX)
Cell Phone (XXX-XXX-XXXX)
*Gender
*Shirt Size

Parent Information

First Name
Last Name
Email
Home Phone (XXX-XXX-XXXX)
Cell Phone (XXX-XXX-XXXX)
*Allergies and any medication you will be taking during the event

Emergency Contact Information

*First and Last Name
*Relationship
*Home Phone (XXX-XXX-XXXX)
Cell Phone (XXX-XXX-XXXX)

Additional Information

Grade:
Parish:

Comments

Are you currently under the care of a physician, being treated for a chronic condition, or on prescribed medication? Do you have any food allergies or special food needs that we should be aware of?

Please hit button only once:

908.500.3300
P.O Box 4292, Warren, NJ 07059

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