Important to Read:

Please note that completing this form does not secure your spot on a trip.  Once you have completed the following, you must go to antiochfc.org/give and find the payment option for Wilderness Trip Deposits.  Upon paying the non-refundable $50 deposit and the completion of this form, your spot will be secured.  For questions, email info@antiochfc.org

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* 1. Name:

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* 2. Phone:

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* 3. Email:

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* 4. Which trip will you be attending?

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* 5. What is your DOB?

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* 6. Do you think you will need to rent trip gear (i.e. pack, sleeping bag, etc)?

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* 7. Do you have any food allergies? (please list, and if so what is the severity for each)

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