2019 Mission Evansville Group Leader Registration (due March 4)
This form is to register a new group. Individual registrations will be submitted separately.

1 adult participant is required for every 3 youth.

Payments can be made as follows:
Initial Deposit - $60 per person (non-refundable) due with parish group registration by Monday, March 4.
Balance and Individual Registrations are due Friday, April 12.
Please make your check out to "Diocese of Evansville", memo Mission Evansville. Your check will need to be received at the address below within 14 days of your group registration or we will release your spaces.

Cindy Shoulders
Mission Evansville
5779 Epworth Road
Newburgh, IN 47630

Registration Questions - contact Cindy Shoulders
phone: 812-453-6130
e-mail: cshoulders11@gmail.com

Please attend our Group Leader meeting on Thursday, March 14, 6:30 PM to receive the Pre-Trip Planning Packet.

THIS FORM IS FOR ADULT CONTACT LEADERS ONLY. INDIVIDUAL REGISTRATIONS ARE NOT ACCEPTED.

Contact Leader First Name *
Your answer
Contact Leader Last Name *
Your answer
Church *
Your answer
Email *
Your answer
Mailing Address *
Your answer
City, State, Zip Code *
Your answer
Primary Phone Number *
Your answer
Secondary contact leader and email address
Your answer
Has your church attended a work camp before? *
Required
If yes, what was the name of the camp?
Your answer
How many YOUTH spots do you want to reserve? *
Your answer
How many ADULT spots do you want to reserve? *
Remember, we require 1 adult for every 3 youth. Adults need to be 25+ years old and successfully completed Safe Protection training and background check.
Your answer
Are you available to come to the Group Leader meeting on Thursday, March 14 at 6:30 PM to receive the Pre-Trip Planning Packets for your participants? *
Can we add you to a Facebook group for contact leaders? *
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