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Event Registration
Please Fill Out Completely Before Submitting
*
Required
Errors
Select Your Event
*
Iowa Mission Trip (June 23-June 30, 2012)
Centri-FUGE (July 8-13, 2012)
Ascend (November 16-18, 2012)
Winter Retreat (January 19-21, 2013)
Name
*
Gender
*
Male
Female
Grade
*
7
8
9
10
11
12
Parent
Leader
Home Phone
*
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)
-
ext.
Cell Phone
*
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)
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ext.
Email
*
Address Line 1
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Address Line 2
City
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State
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ZIP Code
*
School:
*
T-shirt Size
*
S
M
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XL
XXL
XXXL
Parent's Names
*
Parent's Cell Phone Numbers
*
If you have a scheduleing conflict, please explain:
*
Have you completed an Altitude student ministry health form?
*
Yes
No, I need one
Event Cost
*
Iowa Mission Trip $100
Centri-FUGE $325
Ascend $35
Winter Retreat $85
Contact Us
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