516 Missions Group Registration Survey

This Registration Form is to be completed by the Primary Adult Leader after you confirm by Phone or Email there is room for your group for your requested 516 Servant Event Week.

About Group Registration:

• Registrations will be accepted on a first-come first-served basis.

• A non-refundable, but transferable, deposit of $50 per person is due at the time of registration with the remaining $200 per person due May 1st, 2018.

• Due to the nature of this event, youth must have finished 8th grade by the time of the Servant Event to attend.

• A ratio of no more than seven youth to one or two adults is established.

• Questions for registration should be sent to:

Nik Locker

Director of 516 Missions

Phone: (206) 335-3587

Email: servantevents@516missions.com

Mailing Address: 4 Elm Street, Exeter, NH 03833

What happens once you submit your group registration?

-Groups will have 1 week to submit a non-refundable deposit of $50 per person to secure their group slots.

*Please note: to save on credit card fees and keep our costs low, we prefer your payment by check. An additional 3% service fee is added to credit card payments.

See instructions BELOW to pay your Deposit.

-You may add more to your group until the event reaches capacity.

-Should a participant drop out; a Youth may be substituted one for another.

-Once we receive your non-refundable Deposit by check (preferred) or credit card (additional 3% fee added,) we will send you a group registration packet with registration materials and forms.

* 1. Church Information:

Church Name:

Street Address:

City/Town:

State:

Zip:

Church Email:

Church Phone:

Pastors Name:

DCE'S Name:

* 2. Primary Leader Contact Information:

Name:

Street Address:

City/Town:

State:

Zip:

Primary Leader Email:

Primary Leader Home Phone:

Primary Leader Cell Phone:

* 3. What Servant Event Week are you registering for?

516 Middle School Servant Event Week: June 24th-June 29th 2018

516 High School School Servant Event Week 1: July 15th-20th 2018

516 High School School Servant Event Week 2: July 22nd-27th 2018

516 High School School Servant Event Week 3: July 29th-August 3rd 2018

* 4. Number of Participants:

Male Youth:

Female Youth:

Male Adults:

Female Adults:

Total Number of Participants:

* 5. Transportation:

Because we will be breaking up into several work crews, we will be relying on participating churches for transportation to and from the worksites. Please indicate to the best of your ability at this time the following:

Type of Vehicle(S) you plan on brining?

Passenger Capacity of Vehicle(S):

* 6. How did you hear about 516 Missions?

516 Missions Website

LCMS Servant Event Website

Facebook

National Youth Gathering

Word of Mouth

Another Youth Leader

You've Attended 516 Before

Youth Leaders Gathering

Pastors Conference or Circuit Meeting

* 7. Payment Preference:

I wish to pay my group Deposit by credit card through the 516 Missions Website: http://www.regenchurchnh.com/five-sixteen-missions/

(Credit card payments incur an additional 3% service fee.)

I will send my $50 per participant Deposit by check.

• Checks should be made out to “Regeneration Church” Memo Lined “516 Week (your week number)” and mailed to the church office @ 4 Elm Street, Exeter, NH 03833.