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Country Roads TEC Application
TEC #1 Nov 10-12 (Veterans Day weekend)
St. John XXIII Pastoral Center
100 Hodges Rd
Charleston, WV 25314
Contact: markhaascatholic@gmail.com
Email address *
Name *
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Home Address *
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Cell Number *
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Age *
Birthdate *
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DD
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School *
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Grade *
High School Graduation Year *
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Parish that you are a member of
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Pastor
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How did you hear about TEC? *
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Dietary Restrictions/Allergies *
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Pertinent Medical Information
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