Online Registraton Form

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Registrations have now closed       Please complete the form below to register (one household per form) Name of person paying:   Name is required Address of person paying:   Address is required Phone: Email:   Email is required  Invalid address     Church attended: Please select None Crosspoint Church, Palmerston North Emmanuel Church, Auckland Grace Bapist Church, Christchurch Gracenet Community Church, Wellington Covenant Grace Baptist Church, Timaru Rolleston Baptist Church, Rolleston Shore Baptist Church, Auckland South City Church, Auckland Trinity Reformed Baptist Church, Hamilton West Church-plant of SBC, Auckland Howick Baptist Church, Auckland Other (please enter the church name and location below) Please make a selection: if 'Other' is chosen enter name & location below.       How many people will be attending from this household? 0  1 2 3 4 5 6 7   Please select Please enter their names and details below: Name   Attending as Fee Please select Camper aged 13 Camper aged 14 Camper aged 15 Camper aged 16 Camper aged 17 Camper aged 18 Leader/Cook/Helper Child of L/C/H aged 0-3 Child of L/C/H aged 4-12 $ Please select Camper aged 13 Camper aged 14 Camper aged 15 Camper aged 16 Camper aged 17 Camper aged 18 Leader/Cook/Helper Child of L/C/H aged 0-3 Child of L/C/H aged 4-12 $ Please select Camper aged 13 Camper aged 14 Camper aged 15 Camper aged 16 Camper aged 17 Camper aged 18 Leader/Cook/Helper Child of L/C/H aged 0-3 Child of L/C/H aged 4-12 $ Please select Camper aged 13 Camper aged 14 Camper aged 15 Camper aged 16 Camper aged 17 Camper aged 18 Leader/Cook/Helper Child of L/C/H aged 0-3 Child of L/C/H aged 4-12 $ Please select Camper aged 13 Camper aged 14 Camper aged 15 Camper aged 16 Camper aged 17 Camper aged 18 Leader/Cook/Helper Child of L/C/H aged 0-3 Child of L/C/H aged 4-12 $ Please select Camper aged 13 Camper aged 14 Camper aged 15 Camper aged 16 Camper aged 17 Camper aged 18 Leader/Cook/Helper Child of L/C/H aged 0-3 Child of L/C/H aged 4-12 $ Please select Camper aged 13 Camper aged 14 Camper aged 15 Camper aged 16 Camper aged 17 Camper aged 18 Leader/Cook/Helper Child of L/C/H aged 0-3 Child of L/C/H aged 4-12 $   TOTAL registration fee: $ Payment by: Please select Cheque Direct Credit NZ Credit Card via PayPal Aus or other Credit Card via PayPal A selection is required Payment processing fee: $   TOTAL amount due: $ Optional Message: Please enter the image word:

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