2023 Winter Young Adult Retreat

Name

Date of Birth

Sex

Male
Female

I am attending as...

Participant
Volunteer/Staff

T-Shirt Size

Mobile Phone Number

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Mailing Address

Home City/Village

Ministry Site

I Would Like Help With Transportation to the Retreat

Do you need housing at the camp?

Emergency Contact Name

Emergency Contact Phone

Please list any medical issues, allergies, or medications:

Please list any other information you would like us to know:

A signed waiver by event participant or parent/guardian will be required before you can download your QR code. A link to obtain waivers for all registrants will be shown on the confirmation page.

Scholarship request

CYAK has limited scholarship funds for retreats. By checking this box, you are stating that you pursued other funds and still need financial assistance to attend. We ask that you contribute at least $25 toward your registration fee.

Registration cost

$100.00

Total

$100.00

Coupon Code

Billing Information

Name

Payment Method

Credit Card
Pre Register

Credit Card

Visa
Mastercard
American Express
Discover

Address

Mobile Phone Number

2023 WINTER YOUNG

ADULT RETREAT

Victory In Winter

Location Information

Billing Information