Group Registration Form

AMPLIFY 2008 Group Registration Form DUE: November 4th (Tuesday) Church or Group Name: ________________________________ Minister or Lead Representative (thatʼs you): ____________________________ Best phone # to contact you: ___________________ # of Students attending: ________ # of Adults attending (must send one adult for every 10 students): _______ Student breakdown: # of female students: ______ # of male students: ______ # of female adults: ______ # of male adults: ______ Financial breakdown: A check for your groupʼs total pre-registration cost must be included with this registration for your group. # of students _____ x $50/student = $_________ # of adults ______ x $35/adult = $_________ TOTAL AMT INCLUDED (student + adult fees) = $_________ You should also have included the registration forms for the Event, Adventure Program and Code of Conduct forms for each student with this form. By signing below, you are stating that you are authorized by the group or church stated above to register the group or church as participants for “AMPLIFY 2008.” Your registration costs are transferrable but are non-refundable. _____________________________________________ Signature

_____________________________________________ Print Name

_____________ Date

Mail this form, along with registration forms and a check for the total money above, to: First Christian Church ATTN: Youth Ministry Office 39 Cherry St. Columbiana, OH 44408