Re:Fuel South Registration Form
TPYM Presents 2019 ReFuel South - Not the Same

Our Fuel Theme was different last year. Let's not go back to who we were before. Join us for a weekend retreat to remind us of how lives are changed when Jesus enters in.

When: Friday, Nov. 15th @ 5:00P.M. – Sunday Nov. 17th @ 1:00P.M.

Where: Blood River Church, 23595 Blood River rd., Springfield, LA 70462

Who: Ages 9 and Up

Cost: $85.00 (Form and $40 deposit must be turned in by Oct. 24th for this rate)

Send payment to: PayPal.me/bloodriverchurch - Add names of those being registered in the note section.

Or by mail to:

Blood River Church, 23595 Blood River rd, Springfield, La 70462


Make Checks out to: Blood River Youth

Email address *
Name *
Your answer
Email *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone number *
Your answer
Gender *
Required
Age *
Your answer
Grade (If graduated, Post High) *
Your answer
Church *
Your answer
Emergency Contact *
Your answer
Emergency Contact # *
Your answer
Comments
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service