Group Registraion

• Leader's Name
• Email
• Phone
• Age
• Address
• City
• State
• Zip
• Group Name
• Group Address
• Group Website or Email
• Select Weekend May 23 – May 25 June 27 – June 29 July 18 – July 20 August 22 – August 24
• How did you hear about us? David Crowder Concert Advertisement Alumni Bart Campolo Board of Directors College Counselor Conference/Festival Family Friend Pastor Shane Claiborne Speaker Staff Starving Jesus Team Member Tony Campolo Website Other

Group Participants (please include age and gender, ie. John Doe, 25, M)

Note: Liability waivers must be signed (by each participant) and turned in by the registration date.

Sign up to recieve email newsletters from Mission Year!

• Name
• Email