YOUTH 2019 I Urban Plunge Experience - Registration Form

  Cost: $800 per person before January 18, 2019 ($900 per person after January 18, 2019)
Grades: 6-12 and Adult chaperones  

Church City

Church Name

Youth Leader's Name

Youth Leader's Email

Attendee's Name

Home Address

Attendee's Email Address

Phone Number

Date of Birth

Gender

Male

Female

Ethnicity

Grade:

T-shirt Size

Dietary Needs

Allergies and/or Major Health Concerns

Roommate Request

Emergency Contact Name

Relationship to Attendee

Emergency Contact Phone

Emergency Contact Email

A deposit of $150 is due at registration.

A second payment of $300 is due January 18, 2019.

A final payment of $350 is due by May 30, 2019.

There are TWO OPTIONS for making payments:

Make check payable to: Dakotas United Methodist Camps
Mail check payment to: Dakotas-Minnesota Area Central Camping Office, 122 W Franklin Ave., Suite 400, Minneapolis, MN 55404. Please DO NOT mail payment to the Dakotas Conference Office. This will delay your registration.
Process a credit card over the phone by calling our office at 855-622-1973.

UMC