Name:

Gender:

Street:

City:

State:

Zip:

Expected High School Graduation Year:

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 $30 round trip? (If so, simply include with registration payment or bring your money the day of the event...)

Please indicate here if you would like information about discounts.  The best way to receive a discount is to take part in Miles For His Mission on May 7th. Please see our website for information on Miles for His Mission.  Significant discounts apply by participating in Miles for His Mission. 

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

 Email: