Infusion 2020 – Application & Payment Form Remember answers on this browser? Stores your answers incase the browser closes. (Not recommended on public computers) PhoneStudent Information:Hey there, you can use this form to apply and pay for Infusion 2020. At the end of this form you'll be asked to pay the tuition fee so please make sure and have the card you'd like to use ready. A portion of this payment will count towards your non-refundable $15 application fee. Which experience are you signing up for? * Please Select... Infusion Online - August 13th-15th August Lancaster In-Person (residents only) First Name: * Last Name: * Email Address: * Phone Number: * Date of Birth: * Age: * Gender: * Boy Girl Grade level 2020-2021: * Please Select... 8th 9th 10th 11th 12th Timezone Region: Please Select... EST - Eastern Standard Time CST - Central Standard Time MST - Mountain Standard Time PST - Pacific Standard Time HST - Hawaii Standard Time Other T-Shirt Size Please Select... Small Medium Large X-Large XX-Large Triple XL Shirts are standard adult sizes.Parent/Guardian Info: Parents First Name: * Parents Last Name: * Parents Email: * Parent's Address: * City: * State: * Zip: * Group Information: How will you be watching? With my youth group With friends By myself Names of friends you'll be watching with: Personal Information:Tell us about yourself… What was your salvation experience... Why do you want to be a part of Revival Training? What are you hoping to learn/grow in? What is revival to you? Do you have a dream for your High school, if so; what? What topics would you like to hear about during Revival Training? List any symptoms you've had with mental illness i.e. depression, anxiety, suicidal thoughts, self harm, ADHD, ADD, bipolar disorder, PTSD, eating disorder**Build Your Team: How many people do you think you can gather? Me Myself and I 1-5 5-10 15-20 25+ Would you want to have CRYTH Staff come and facilitate this training? Yes No Could you provide housing for 3-5 Circuit Riders? Yes No Where could you gather? Are you parents stoked? Yes No Payment Information: Payment AmountYour card will be charged today. For tuition cost minus early bird discount if applicable. First Name: * Last Name: * Email Address: * A payment receipt will be sent to this email address. Expiration Date: * CVC: * Zip/Postal Code: * Credit Card Number *
