OREGON 2020 REGISTRATION

STUDENTS MUST BE INVOLVED IN ONE OF OUR BIBLE STUDY GROUPS IN ORDER TO BE ELIGIBLE FOR THIS TRIP

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Name exactly as it appears on your Drivers License ( Include middle name before last name) Example. Aaron John Werner *

First

Last

Name exactly as it appears on your passport if you have one (Inclue middle name before last name like above) *

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Last

Your Cell Phone Number *

Current Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Your Birthdate *

Emergency Contact Name *

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Last

Emergency Contacts Number *

Have you ever been discipled? *

NO YES

What are you doing right NOW to improve your relationship to God? *

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