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2008 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
June 8
to
June 14
June 22
to
June 28
July 6
to
July 12
July 20
to
July 26
First Choice
In the unlikely event that we are not able to give you your first choice, please indicate your second choice:
Fill in comments here.
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
Last Updated: Apr 28, 2008