Agape On The Road Registration

Group Leader Name *

First

Last

Position *

(ex: Youth Minister, Teacher, Volunteer, etc.)

Email *

Work Phone

Cell Phone *

Parish / School *

Parish / School Address *

Address Line 1

Address Line 2

City

State

Zip Code

Select the age group of your participants *

Estimated number of youth participants *

Estimated number of adult participants *

Agape Weeks - Please indicate your FIRST choice *

Agape Weeks - Please indicate your SECOND choice (copy) *

If you agree to the following terms, please respond ‘Yes’: *

If you agree to the following terms, please respond ‘Yes’: I have read the registration brochure and understand the registration policies, including that upon submission of this registration form, the Archdiocese will invoice the parish for the $500 non-refundable registration fee.

Do you have any questions or comments?

Agape On the Road Registration