First Name

Last Name

Street Address

City

State

Zip Code

Phone Number

This is my...

Home Phone

Cell Phone

Work Phone

Is it ok to send you SMS?

Yes

No

Email Address

Confirm Email

Have you attended ANY MEYouth.com Retreats in the past?

Yes

No

Age

Gender

Male

Female

Birth Month

Birth Day

Birth Year

Free T-Shirt Size
(Not guaranteed for Late Registrations)

Responsible Party

Do you have an approval from your youth leader to attend the retreat?

Yes

No (We will contact you for more info)

Please Select Your Youth Leader

Adel Abrahim

Albert Baskaron

Bashar Ellis

Esam/Dina Boktor

Faris Nesheiwat

Hani Bushra

Magdy Naguib

Maged Tawadros

Moody Wasif

TurnAround Ministries

Other Youth Leaders

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Registration Fee and options

Retreat Registration Fee:

I want to make the full payment of $165+$20 Late Fee through PayPal® now.

I served at the 2008 Youth Retreat as a Student Leader. [50% Discount] $92.50

Optional Donation:
We need to finish this year's retreat strong with no outstanding costs weighing us down. Will you help us meet this financial challenge with an additional Tax-Deductable Gift.
(Gift recipe will be mailed to the name & address on PayPal®.)

Other Donation Amount

Any Comments, concerns, prayer request or praise?

Any Comments, concerns, prayer request or praise?

How did you hear about this retreat?

Terms and Conditions

Retreat Rules

Housekeeping rules will be announced at the retreat. Other than that, just make sure your actions are wise, Godley and respectful to the retreat leaders and attendees.

Release Agreement

Release of liability agreement will be given to you to sign at the retreat.

Agreement to Retreat Rules and Release agreement conditions:

I agree to the Retreat Rules and Release agreement conditions.

Instant payment required

I also understand that any registration without an INSTANT PayPal® payment will be VOIDED automatically.

Refund Policy

I understand that there is no registration refund except for health and/or emergency issues.

Indicates Response Required