Challenge Houston Club

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

2022 High School Retreat

Registration

Qty

Description

Amount

Total

Retreat Registration

$80.00

DISCOUNT CODE

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Donation for RC High School Ministry

Donation Amount

Total: $80.00

Participant Information

First Name: *

Last Name: *

School: *

Grade: *

E-mail: *

Cell Phone #: *

Date of Birth: *

Age: *

Allergies:

Food / other

Are you a member of ECYD or RC?

How did you find out about this retreat? *

Mother's Full Name: *

Mother's Cell Phone #: *

Mother's E-mail: *

Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone: *

SWEATHSIRT SIZE *

E-mail: *

A receipt will be e-mailed to this address.

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *