Application: Church Relations

Young People's Christian Assembly Registration Form

July 15 - 18, 2012

Instructions: Submit this completed form by clicking on "Submit" below.

Pastor's Name: Last 
First MI

Church:

Address:
City:   State:  Zip Code:
Country:

Phone Number:

E-mail Address:

Number of Sponsored Youths attending the YPCA:

If no chaperone sent, please list name of:
Contact Person:
Contact Person's Phone Number:

Name(s) of Sponsored Youth(s)/Chaperone(s)
(include Age, Male/Female and Year of Attendance ... 1st, 2nd, 3rd):

Enter cost to be paid to attend YPCA: $

Note: the cost per person, including chaperones, is $120.00. This includes food and lodging. Registration Deadline July 2, 2012.

REMEMBER - THERE WILL BE NO ON-SITE REGISTRATION!

THIS COMPLETED FORM AND PAYMENT WILL BE SENT TO:

Office of Church Relations
Benedict College
1600 Harden Street
Columbia, South Carolina 29204

Previous Page