EmailMe Form - Dream Land 꿈땅 Senior B First Retreat!!

Name of Child 1 (이름) *

First Last

Grade of Child 1 (현제 학년) *

4th Grade

5th Grade

6th Grade

T-Shirt *

Small

Medium

Large

To register additional child(ren), please continue to fill out the form or skip to the next section.

Name of Child 2 (이름)

First Last

Grade of Child 2 (현제 학년)

4th Grade

5th Grade

6th Grade

T-Shirt

Small

Medium

Large

Please Complete All Registration Information Below.

Name of Guardian 1 (부모) *

First Last

Phone *

### - ### - ####

Email *

Name of Guardian 2 (부모)

First Last

Phone

### - ### - ####

Fee (회비) *

Regular $100 (Child 1)

Regular $100 (Child 2)

Enrollment Fee applies per child.

신청 방법 *

Credit Card

Submit 을 누루시면, Authorize.net Page 로 이동하게 됩니다. 카드 정보를 바로 입력하시면 됩니다.

Name on Card (영문) *

First Last

Billing Address (카드 청구지 주소) *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

By clicking the Submit button, I give authorization to NJ Onnuri Community Church to charge my credit card in the amount indicated to enroll in the "Dream Land Senior B Retreat."

Special Request/Comments

Email