180 Fuge Summer Camp Registration
Cost: $300
Date: June 10-14 2019
Location: Centrifuge @ Shalimar Retreat Center, Panama City, FL

For any comments or questions please contact Pastor Justin at:
(704) 618-6144 or Justin@fellowshipofmadison.com

Student's Name *
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Parent Email *
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Parent Phone #
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Current Grade *
Dietary restrictions & Allergies *
What Church do you currently attend? *
T-shirt Size *
I understand that I will have to pay the first payment $150 by April 21, and remaining balance by June 1st. *
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