July 5, 2008
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Impact 2008 Impact Registration Teen Info Form
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Registration Form

Indicates required field
Group Info
Group Name:
Group City: State:
Contact Person:
E-mail:

Check here if this is an addition or correction to a previous order:

Contact Details
Address:
City: State: Zip:
The above address is: Ministry   Home
Home Phone:
Church Phone:
Other Phone:

Event Details
Fees:  
 		1) $25.00 per student ($15 deposit required)
2) $5.00 per Adult youth leader
 
*Indicate number attending
Adult Leaders
Male:
Female:
Junior Highers
Male:
Female:
Senior Highers
Male:
Female:
  
T-Shirts: $8.00 ea. Available during IMPACT.
*Deposit Due:
Remainder Due at Registration:
Grand Total:

*Deposit can be made by credit card over the phone, or mailed in. Registration will NOT be complete until deposit is received. Details on next page.

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© 2008 Appalachian Bible College
P.O. Box ABC - Bradley, WV 25818 - 1.800.678.9ABC
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