B3 Youth Weekend-March 15-17, 2019

2. B3 Youth Weekend Registration-Cost $30
   Friday, March 15, 7:000 pm- Game Night; Saturday, March 16, 9:30 am-Seminar 1:00 pm Bowling Fellowship; Sunday, March 17, After Service- Dave and Busters

   Friday, March 15, 7:000 pm- Game Night; Saturday, March 16, 9:30 am-Seminar 1:00 pm Bowling Fellowship; Sunday, March 17, After Service- Dave and Busters

4. Contact Information

6. First Name

7. Last Name

9. Address

11. City

12. State

13. Zip

15. Contact Telephone Number

16. Email

18. Who is attending?

    1. I am registering myself
    2. I am registering someone else

20. First Name

21. Last Name

22. X
    -- Select One --Registration $30

24. Who is attending?

26. First Name

27. Last Name

28. X
    -- Select One --Registration $30

30. First Name

31. Last Name

32. -
    -- Select One --Registration $30

34. First Name

35. Last Name

36. -
    -- Select One --Registration $30

38. First Name

39. Last Name

40. c
    -- Select One --Registration $30

42. Total Number of Participants

43. Total Payment

    Payment will be processed on the next screen.

45. Checks can be mailed to Shiloh Baptist Church-Youth Weekend, 1429 Duke Street, Alexandria, VA 22314

47. Please contact Rev. Mark Montgomery at markmontgomery@shiloh-bc.org for additional assistance.

Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field