Rockbridge Fall Weekend

WHERE: Rockbridge

WHEN: October 25, 2024 - October 27, 2024

Departure: Friday, Oct 25th @ 3pm

Return: Sunday, Oct 27th @ 5pm

COST: $170, a deposit of $25 is required to hold your spot.

Money is nonrefundable after Oct. 20th

After completing this form, a confirmation will be sent with the information you have entered below.

Questions and Information

Contact at the Young Life Office at:

P.O. Box 553 Leonardtown, MD 20650

[email protected]

Participant Information

Guest Type

Registration Options

Register with a deposit or full payment ($170.00) [24 remaining]
Please select to make a deposit or full payment below. This will be paid by credit card.
Leader ($0.00)

Participant Name

Date of Birth

Phone

Phone Type

Participant Address

Gender

Male
Female

Ethnicity

T-shirt Size

School

High School Graduation Year

Parent / Guardian Information

Parent/Guardian Name

Parent/Guardian Phone

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Phone Type

Parent/Guardian Email

Address is same as participant*

Address

Would you like to cover the 2.5% processing fee?

Total

$0.00

By filling out this form, you are opting in to Young Life communications.
In the future, you will be given the opportunity to manage your communication preferences.

Billing Information

Name

Payment Method

Credit Card
Cash/Check/Offline

Credit Card

Visa
Mastercard
American Express
Discover

Address

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