2017 CMC West | Dec. 26-29 Registration
All information about CMC here: http://bit.ly/17cmcwest

Dates: December 26-29, 2017
Location: Ontario Convention Center, Ontario, CA
Price: $100 (Flight Ministry only) by Sunday, Nov 5 at 11:59:59 PST
Others: $135 (if not from FCBC, please contact Darren)

Includes: Registration, Food, Transportation, Accommodations
First 25 Flight Student sign ups get a free gift!
There is no regular or late fee! The price significantly jumps after Nov 5!

Make checks to "First Chinese Baptist Church"
Questions? Contact Darren Lo (darrenlo@fcbc.org)
Name *
First & Last
Your answer
Gender: *
Year in College *
Primary Phone Number *
w/ area code: (xxx)xxx-xxxx
Your answer
Primary Email Address: *
This is how you're getting info.
Your answer
Emergency Contact Name *
(First & Last)
Your answer
Emergency Contact Phone Number *
To reach him/her in case of emergency
Your answer
Are you a Christian? *
Do you have a personal relationship with Jesus Christ as your Lord and Savior?
If you do not attend FCBCLA, who invited you to this conference?
First & Last
Your answer
Request Parking in the Church Garage during conference?
(It is best if you get dropped off or carpool to church). Complete if YES only. Please leave a) License Plate Number, b) Make of Vehicle, c) Model
Your answer
How much do you think Darren can bench? *
(be honest)
Health Insurance Provider *
If none, please indicate 'none'.
Your answer
Health Insurance Member/Policy Number *
If not applicable, write 'na'
Your answer
Medical Information *
Please indicate if you have any allergies or health conditions. (Information will remain private to retreat staff.) If none, indicate 'None'
Your answer
Please list any medication(s) you are taking (in case medical staff must be made aware).
Your answer
Special Dietary Needs/Concerns
List any food allergies, vegetarian diet, etc.
Your answer
Health Screening Availability: Please READ and acknowledge. *
The State of California requires that each camper have a health screening before arriving at a campsite. On the morning of departure each camper will be screened for recent nausea, vomiting, diarrhea, elevated temperature, transmissible conditions (i.e. lice), and exposure to illness. If you are sick or have any of the aforementioned conditions, please DO NOT attend retreat. While we value your presence, your condition could likely get others ill. ("Seek the interest of others ahead of yourself.") A refund will be provided. In addition, some forms will be provided to you in advance to complete.
I hereby release and waive any liability against First Chinese Baptist Church - L.A., its officers, employees and volunteers for any injury that may incur as a result of participating in this camp. Should it be necessary for me to have medical treatment while participating in this activity, I hereby give First Chinese Baptist Church permission to act on my behalf to secure any hospitalization or medical services deemed necessary and appropriate by the physician and absolve said First Chinese Baptist Church from any and all forms of negligence and wrong treatment incurred in the procurement and process of hospitalization and medical treatment. First Chinese Baptist Church has my permission to obtain emergency medical treatment for me at the expense of myself and/or my insurance company.
Interested in serving with the Children's Program?
Children's Program Volunteers will get another discount. Requires training and will miss parts of the main sessions.
Do you need campership?
A church fund is provided to assist with the cost of camp for those who truly cannot afford the full expense. In exchange, you volunteer some time and energy with tasks at church or specific sites.
Comments? Questions? Suggestions?
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy