Your Name (required)
Address (required)
City (required)
State (required)
Zip (required)
email (required)
phone (required)
Marital Status (required) MarriedDivorcedSingleWidowed
Spouse Name
Spouse Phone
Number of Children

Family Member other than Spouse to contact in case of Emergency:

Name (required)
Phone (required)

Your Background

Date of Birth
Church Name
Pastor/Priest/Minister's Name
Church Address
Church City
Church State
Church Zip

Weekend You Wish To Attend?

Sponsor's Name (required)
If you don't have a sponsor, enter 'I Need One'.
Sponsor's Phone
Sponsor's email
Name to be used on name tag

Medical Questions

Do you have any special dietary requirements? YESNO
What kind of dietary requirements?

DiabeticVegetarianLow SaltGluten FreeOther:

Do you require medications at specific times each day? YESNO
Do you have any health or physical restrictions that require special equipment or facilities? YESNO

If you answered "YES" to the above medical questions, Please give us some details so that we may assist you on YOUR weekend. If you want someone to call you regarding special needs, please let us know.


Please talk to your sponsor regarding the cost of the week-end. If you are paying for the weekend, the cost is $120 (This includes the $20 application fee). You can conveniently use the PayPal 'Donate' on the right edge of this page towards to top to pay. If you can not pay for the week-end please talk it over with your sponsor. Additionally, there are scholarships available, contact the Pre-Weekend Chair for more information.