Agape On the Road Registration

Agape Service Project 2023 - Registration

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Group Leader Name

First

Last

Position

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

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

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?