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CHRYSALIS 48

Nov. 21,22 & 23, 2008
Location: First United Methodist, Billings, MT
Final Application Deadline: Nov. 14, 2008
$15 Early-Bird Discount if registered by: Nov 7, 2008
Application Fee: $80

Scholarships available! Contact Us for more info.

Fields marked with a * are required

First Name:*
Last Name:*
Applicant Address*
City, State Zip:
Phone:*
Email:
Name tag preference:*
Birthdate:*
Grade:*
School:*
Sex:* Male   | Female
T-shirt Size:
Church:
Dad's Name:
Dad's Address, City, State Zip & Phone #
(if different):
Moms Name:
Mom's Address, City State Zip & Phone #
(if different):
Youth Pastor:
Pastor:
Physical condition or illness that might need consideration:
Prescriptions required:
Special diet requirements:
Does candidate give permission to print their information on Chrysalis lists?:
Check to indicate candidate's signature*:
Check to indicate Parent signature*:
(These both must be signed by checking to have your application processed)

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