Northwestern College campus

LYF Registration

June 24-29, 2018

PERSONAL INFORMATION

Please provide the following information.

REFERENCES

Reference #1

Please provide the name of a pastor or youth leader who can recommend you for this program.

Reference #2

Your second reference may be a different pastor or youth leader or may be a teacher, mentor or friend. (Neither reference should be a family member.)

PAYMENT

Please provide the following credit card information.

For Visa, Mastercard, and Discover (left), the 3 digits on the back of your card.
For American Express (right), the 4 digits on the front of the your card

Total amount

$175.00
This is the amount that will be charged to your credit/debit card.