Please complete the registration form. All required fields are marked in bold italics.

General Information

First name
Last name
Address
City
State
Zip code
Example: xxxxx or xxxxx-xxxx
E-mail
Example: cobworkcamps_gb@brethren.org
Re-enter e-mail
Day phone
Example: xxx-xxx-xxxx
Evening phone
Example: xxx-xxx-xxxx
Gender
Birth date
Example: mm/dd/yyyy; please note that if your day or month is only one digit, you must enter a leading zero (i.e. 03 for March)
Church code
Clear Box		  
Every Church of the Brethren congregation has a five-digit code that uniquely identifies it. Please click here to find your church code.
T-shirt size  


Role

Please specify your role.    
If you are in junior high or senior high, please specify:
The grade you will have completed at the time of the workcamp.    
Your school.    

Workcamp Choices

Please select your first and second workcamp choices
First choice
Second choice

Payment

A minimum of a $100 deposit must be made at this time, with the balance due by April 1, 2008. Please enter the deposit amount you will be sending in the box below. If your youth group is paying in one check, please enter the amount that is designated for your individual registration.
    $


   



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