Sponsoring Church or Association ________________________________________

Contact Person (Mr./Mrs./Ms./Rev./Dr.) ____________________________________

Address _____________________________________________________________

____________________________________________________________________

Contact Phone (day) __________________ (night) ______________________

Fax __________________ e-mail ______________________

Dates Preferred: 1^st choice _________ 2^nd choice ________ 3^rd choice __________

Age Range of Group (grades 7-12): middle school ______ high school _______

If an Episcopal priest will accompany your group, please list his/her name & phone #:

________________________________________________ ________________

                                                                # of Youth &
                                                                     Adults                Totals

God Search Weekend Program $55 X _______ = _______

(includes Skipjack Tour & Pizza Break)

                     Saturday night (optional) $10 X _________ = ________

           Historic St. Mary’s City tour (optional) $5 X _________ = ________

Total due- - - - - - -  - - - - - - - - - - - - - - - - - - - - - - - - _______

Deposit enclosed (1/2 of Total Due) - - - - - - - - - - - _______

Balance due one week before scheduled weekend  _______