February Getaway Weekend registration form

Contact Information
 
Name
 
 
Address
 
  
 
 
 
Phone
 
 
Cell Phone
 
 
E-mail
 
 

 
Parents' names
 
 
Parents' e-mail
 
 

Other Information
 
Pickup location?
 
 
 
High School Graduation Year
Note: If you are not currently a Junior or Senior, please contact us before registering.
 
 
 
High School
 
 
Academic Interests
 
 
Extra-curricular Interests
 
 
My level of interest in Bethany is
  
 Very high
 High
 Moderate
 Low
 
Gender
  
 Female
 Male
 

There is a $40 deposit per registrant for this event. (Each person must register separately.) You will confirm your registration details on the next page.

This page is secure.


Extended Validation Certificate