Registration Form Registration Form by KevinCrouthers

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									Registration Form

Name___________________________________ Church: _________________________________

Address: _________________________________ City/Zip: _______________________________

Email: ___________________________________ Phone: ________________________________

Age Group: college / young adult / adult / senior

T-Shirt Size: ________                  Early Registration: $157 until July 31
                                        Late Registration: $177 until August 14
                                        Space is limited to the first 100 men. Sign up early!



Payment info: make checks payable to “PCJC” and mail along with this form to:
“PCJC Men’s Retreat” : 4871 Centinela Avenue, Los Angeles, CA 90066 .




Registration Form

Name___________________________________ Church: _________________________________

Address: _________________________________ City/Zip: _______________________________

Email: ___________________________________ Phone: ________________________________

Age Group: college / young adult / adult / senior

T-Shirt Size: ________                  Early Registration: $157 until July 31
                                        Late Registration: $177 until August 14
                                        Space is limited to the first 100 men. Sign up early!



Payment info: make checks payable to “PCJC” and mail along with this form to:
“PCJC Men’s Retreat” : 4871 Centinela Avenue, Los Angeles, CA 90066 .

								
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