EmailMe Form - LIFT Tour Registration

Name: *

First Last

Phone *

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

Email *

Gender *

Male

Female

Parent or Guardian's Name: *

First Last

Parent or Guardian's Phone: *

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

Parent's Email *

Grade: *

School : *

Emergency Contact Name *

First Last

Other than parent

Emergency Contact Phone *

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

Would you like to pay online? $60 plus online fee. *

Yes $60 LIFT TOUR +$2 online fee

No

Payment must be received for registration to be valid. (Online processing fee of $2) and payment is processed through paypal. If you choose to pay by check your registration is not considered complete until the check is received.