Registration Information
Please print and send this form to
Xstream Youth Church
First Assembly of God
108 Beck Lane
Lafayette, IN 47905
Last Name __________________________________________
First Name __________________________________________
Church Name & City ___________________________________
Home Address _______________________________________
City ________________________________________________
Phone # ( ____ ) _____ - ________ State ____________ Zip ____________
E-mail ____________ @ ______________
Please check which applies to you:
ڤ Youth Pastor ڤ Youth Leader ڤ Senior Pastor ڤ Adult from Church
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Please list all TW200 1 Gathering attendees below. If you need more blanks, please fill out the back. |
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Youth Pastor/Adult Leader |
Student Registration |
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Last name |
First name |
$25.00 |
$15.00 |
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TOTAL: |
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$ |
