Summer 2009 Retreat Registration
Please fill out the information below to register for the retreat.
Email registration@180m.org if you have any questions.
COST:
$180 (Checks made payable to Radical Reversal Ministries)

*First Name*Last Name
    
*Gender
   
*Age
    
*Grade
   
*Home Church
   
Home Church (if not listed)
*Email
    
*Re-enter Email
    
*Emergency Contact
   
*Emergency Contact Phone Number
() -         

*T-Shirt Size