Mid Winter Event Group List Worksheet
Use this printable form to gather information for entry into the registration system.

  
Church: ____________________________________________________
    
Contact Name and Phone: _____________________________________
   
Teens:
  1. ________________________
  2. ________________________
  3. ________________________
  4. ________________________
  5. ________________________
  6. ________________________
  7. ________________________
  8. ________________________
  9. ________________________
  10. ________________________
  1. ________________________
  2. ________________________
  3. ________________________
  4. ________________________
  5. ________________________
  6. ________________________
  7. ________________________
  8. ________________________
  9. ________________________
  10. ________________________
Adults: Concert Only:
  1. ________________________
  2. ________________________
  3. ________________________
  4. ________________________
  5. ________________________
  6. ________________________
  1. ________________________
  2. ________________________
  3. ________________________
  4. ________________________
  5. ________________________
  6. ________________________

Make checks payable to: WV North District NYI

Total number (Concert & Falcon Center): ____  x $25 = _______

Total number (Concert Only):                 ____  x $10 = _______

                                                                      Total: __________