When: 

Departure Date & Time:

Departure Place:

Return Date & Time:

Where:    

Cost:           

Deposit:        

Additional Information:

Program Information:

Ridgecrest Conference Center: 

Contact:

June 2-10 2006

June 2^st, 9:00 a.m

Eastminster West parking lot

June 10^th, 4:00 p.m.

Ridgecrest LifeWay Conference Center, Ridgecrest, NC

$300

Should have already been turned in ($50)

Contact the church office @ 723-8371

www.studentlife.net

Ridgecrest

Ivan Martinez (723-8371)

    Complete the application below to register for Student Life 2006.  You are not considered fully registered until the deposit and fee has been settled and you have been contacted by a Power & Light staff member.

* Your first & last name 

* Your address      street 1  

* Your address      street 2  

* city  

* state

* zip   

* Phone number where we can contact you

* Your email address     

* Your parents name 

* Your parents email address    

* T-Shirt size    S  M  L  XL  XXL

   Have you discussed this trip with you Parents?   Yes   No

   Have you paid the deposit?  Yes   No

   First time for Student Life?   Yes   No