2012 Trip Registration
Please Complete This Form
Contact Person:
Church:
Address:
Address:
City
State
Zip
Day Phone:
Eve Phone:
Fax:
Email:
# of Students
# of Adults
Select Preferences, Make Comments, Then Submit
 
In the unlikely event that we are not able to give you your first choice, please indicate your second choice:
A non refundable deposit of $100 per participant (teen and adult) is required. Please mail your deposit to:
Mission Indy, Inc.
57 North Rural Street
Indianapolis, In 46201
Phone: 317-423-3505
Fax:   317-423-3508



We raise money for Mission Indy by
searching the Internet with GoodSearch.com (powered by Yahoo), or shopping online with GoodShop.com.

You can donate directly to Mission Indy using PayPal

Last Updated: Apr 25, 2011