REGISTRATION IS NOW CLOSED FOR THIS EVENT!
REGISTRATION IS NOW CLOSED AS THIS EVENT IS SOLD OUT!

Please fill out the below form for registration for the YP City Escape. Please note that registration will be finalized ONLY AFTER payment is received and tickets are non-refundable and non-transferable. The link for tickets via PayPal will be on second page of this form.

Tickets are $140 and include food, drinks and activities.

Please note that the Event is for 21+

Full Name *
Your answer
Email Address *
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
I) Personal Information
Primary Phone Number (Mobile/Home) *
Your answer
Secondary Phone Number (Home/Mobile/Work)
Your answer
Date of Birth (MM/DD/YYYY) *
**All attendees must be 21+ years old **
Your answer
I am from... *
**All attendees must be 21+ years old **
Required
II) Emergency and Medical Information
This information will remain strictly confidential and only used in case of an emergency.
In case of emergency, contact Name *
Your answer
Emergency Contact's Phone Number (s) *
Your answer
Allergies *
Please type "None" if this is the case
Your answer
Please list any Medical Conditions *
Please type "None" if this is the case
Your answer
III) Accomodation Preferences
Accommodations are on a first come first served basis. Please indicate your preference for rooming:
Accomodation Type *
Note that Cabins will be separated( Girls in valley/Boys on hill)
Rooming Preference : Name 1
Your answer
Rooming Preference : Name 2
Your answer
Rooming Preference : Name 3
(ONLY if "CABINS" Selected)
Your answer
Rooming Preference : Name 4
(ONLY if "CABINS" Selected)
Your answer
IV) Miscellaneous
I will need a car ride to the Camp *
I can provide a car ride to 1-3 people *
V) Payment Information
I understand that registration will be finalized ONLY AFTER payment is received and tickets are non-refundable and non-transferable. *
Required
Payment Method: ( Detail provided next page) *
Tickets are NON-REFUNDABLE and Non-Transferable (See next Page for details)
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