Weekend Application

Last name *

First name *

Email Address *

Phone # *

Birthdate *

Gender *

Male

Female

Street Address *

City *

State *

Zip *

Name of Church *

Pastor

Have you been baptized? *

yes

Sponsor Name *

Sponsor Email

Marital Status *

Married

Single

Wife or Husband's Name

Wife or Husband's Email

Spouse's Phone#

Medical & Dietary Requirements PLEASE NOTE ANY DIETARY OR MEDICAL NECESSITIES YOU HAVE WHICH REQUIRE SPECIAL ATTENTION:

Weekend Fee * Please talk to your sponsor regarding the cost of the weekend ($110). We have a limited number of scholarships available. Let us know if you require a scholarship here.

I do not require a scholarship

I would like to receive a scholarship.

I would like to attend the upcoming Atlanta Lutheran Via de Cristo weekend.