Registration Form
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First Name
Last Name
Which Church do you attend?
Name as you want it to appear on your nametag
Street Address
City, State Zip
Home Phone
Work Phone
Cell Phone
Email Address
Age
Marital Status
Emergency Contact #1 Name
Emergency Contact #1 Relationship
Emergency Contact #1 Home Phone
Emergency Contact #1 Cell Phone
Emergency Contact #1 Email
Emergency Contact #2 Name
Emergency Contact #2 Relationship
Emergency Contact #2 Home Phone
Emergency Contact #2 Cell Phone
Emergency Contact #2 Email
Do you have any special physical, medical, or dietary needs?  Please explain. Note: Holy Trinity does not have elevator services.
How did you hear about the ACTS retreat
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