EmailMe Form - Camp Chalmette 2016 Mardi Gras Registration Form

Last Name *

First Name *

Postal Mailing Address *

City *

State *

Zip Code *

Cell Phone Number *

In case of Emergency (contact number) *

Year of Birth *

Married (Yes or No) *

Occupation *

Email Address *

Church you attend

Any physical limitations?

Please tell us how you came to faith in Jesus Christ. *

What are your personal goals for this trip? *

Is this your first trip? *

If so, who invited you?

Participation Waiver

I agree that my safety is my own responsibility and my attendance on this mission trip is purely voluntary. Further, I agree to release NGL Network and Hands of Hope from any legal responsibility or financial obligation should I injure myself or others due to my own negligence.

Click this box to agree: *

I agree to this waiver.

Participation Waiver

Once you click on the "SUBMIT" button, another page will open detailing how you can pay for this trip. God bless you and we'll see YOU shortly!!

Once you click on the "SUBMIT" button, another page will open detailing how you can pay for this trip.
God bless you and we'll see YOU shortly!!