Name:

Gender:

Street:

City:

State:

Zip:

School Name:

Expected High School Graduation Year:

Please enter the name of school you attend if it was not on the list above.

Parent or Guardian First & Last Name(s):

Primary Phone Number:

Cell or Alternate Student Phone Number:

Parent or Guardian Alternate Phone Number:

Do you own a Campus Way Bible?

Adult Shirt Size:

Do you plan to ride on the bus with Campus Way for $20 round trip? (If so, simply bring your money the day of the event...)

Please indicate here if you are in need of Scholarship assistance.  The best way to receive a discount is to take part in Miles For His Mission on May 2nd. Please see our website for information on Miles for His Mission.  Significant discounts apply by participating in Miles for His Mission.  Even if you are not able to participate you may still request scholarship assistance here, if necessary

Who referred you to this event? Or how did you find out about it?