Troubling the Water Registration

Saturday, March 12th, 2011 from 9 a.m. to 4:30 p.m. at Atonement Lutheran Church, Wyomissing, PA.
This event is open to 9th and 10th graders nominated by their pastor or other staff leader.
Please include all information requested so that we can best communicate prior to event.
Fields marked with an asterisk ( * ) are required.
Pastor Name: *
Congregation: *
Address:
City:
State:
Zip:
Telephone:
Email: *
1).
Youth Name: *
Address:
City:
State:
Zip:
Telephone:
Email:
 
2).
Youth Name:
Address:
City:
State:
Zip:
Telephone:
Email:
 
3).
Youth Name:
Address:
City:
State:
Zip:
Telephone:
Email:
 
4).
Youth Name:
Address:
City:
State:
Zip:
Telephone:
Email:
 
5).
Youth Name:
Address:
City:
State:
Zip:
Telephone:
Email:
 
Adult Leader/Driver (if different than pastor above)

Adult Name:
Adult Address:
Adult Phone:
Email:
The cost of one adult is covered by the youth registration. If second adult is necessary then extra $20 registration is required.
$20 per youth X = $
Make checks for either event payable to:
TEY (memo: Trouble the Water)
and mail to:
Theological Education with Youth
61 Seminary Ridge
Gettysburg, PA 17325
Registration is not complete until payment is received.
Our group would like to receive all communication for this event by email, rather than standard mail.(Checkbox for YES). **Email address for all participants required for this option.

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