USE YOUR TAB KEY TO MOVE THROUGH FORM

Name:       I am: Male  Female
Address:       
City:  State: IN KY OH IL MI Latvia Zip:
Home Phone:      xxx-xxx-xxxx
Alternate Phone: xxx-xxx-xxxx 
E-Mail:     

Church:         
City/State:     
Denomination:

Movement:      Via De Cristo, Brethren Walk, Emmaus, Great Banquet, etc.
Weekend attended:     

Please consider my application for: (Check all that apply)
    North - Spring   Fall  Co-Ed
    South - Spring   Fall  Co-Ed
        Latvia Summer Weekends (team selection begins in February for August weekends)

Please indicate any PREVIOUS TEAM EXPERIENCE you have had:

If experienced as a PROFESSOR, please indicate the rollos given:

Dates you have attended Leaders/Servant's School:

Currently participating in Group Reunion?  Yes    No    

Would you like to be considered as a Music Cha for (check all that apply)
                       Team (instrument not required, just a nice voice)
                       Serenade-Guitar
                       Closing -Guitar or Keyboard
                       Closing - Organ to play "Lift High the Cross"

Additional Comments:

When you click submit, a confirmation page will appear and your information will be forwarded to Jeff Wilcox, our Leader's chair. 
He will then forward it to the appropriate Rector for prayer and consideration. Team members are expected to pay $115 for the
weekend.

 If you have completed the form correctly, you will see a "form confirmation page".  If you don't see the "form confirmation" page, something has happened and you should re-submit it.  It's better for us to receive duplicate applications than to not receive one at all.