Back to the Mountain On-Line Application

"Back to the Mountain" Application

I am (first and last name) *

I worship at (Name of Church) *

I made (weekend and table, if applicable) *

Email Address *

Phone # *

Gender *

Male

Female

Street Address *

City *

State *

Zip *

Medically-necessary Dietary Requirements / Medical conditions we should know about.

Allergies

Room preference *

Shared room - - roommate preference below

Shared room - - no roommate preference

Single room -

If shared room, requested roommate (optional)

Are stairs OK? Some rooms are on the second floor. *

yes

I will pay *

online

mail a check

I would like to attend the upcoming Atlanta Lutheran Via de Cristo "Back to the Mountain" event.