RA Congress Church Hold Form Church InformationChurch Name*Church Billing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Church Phone*Leader InformationYour Name*Cell Phone*Email* How many spots are you reserving for RA Congress?*You should have 1 adult male per 10 male students, and they must be 21 years or older. Jr. counselors are allowed if under 21, but they cannot be the primary chaperone.What method will you pay for deposit?* Pay by credit card with this form Mail a check to Tall Timbers Number of male adult chaperones (include jr counselor helpers in this number) Quantity* Price: $10.00 Quantity Number of male campers (completed grades 1st-3rd "Lads") Quantity* Price: $10.00 Quantity Number of male campers (completed grades 3rd-6th "Crussaders") Quantity* Price: $10.00 Quantity Total people in your group:Total for Credit Card payment today ($10 deposit per person due) $0.00 Number of male adult chaperones (include jr counselor helpers in this number) Quantity* Price: $10.00 Quantity Number of male campers (completed grades 1st-3rd "Lads") Quantity* Price: $10.00 Quantity Number of male campers (completed grades 3rd-6th "Crussaders") Quantity* Price: $10.00 Quantity Total people in your group:LODGING - cabins onlyOnly Cabins will be available for this event. Hotel rooms are only for families or special requests. Each Lee Lodge room holds two full size beds with a bathroom/shower and with towels and bed linens provided. Select Lee Lodge if you need a hotel room Lee Lodge hotel room For families or special requestsType any special needs in regards to lodging below (no stairs, handicap, etc.). If you selected that you needed a hotel room, please list their names and relations below and reason requested.Estimated Total for RA CongressYou will be billed the remainder of the event balance after RA Congress based on actual numbers. This total does not include late fees or deposit forfeitures.Estimated Total for RA CongressYou will be billed the remainder of the event balance after RA Congress based on actual numbers. This total does not include late fees or deposit forfeitures.Total Deposit Amount ($10 per person by check)This will be applied toward the total price.Deposit Owed Today ($10 per person):This will be applied toward the total price.PAYMENT FOR DEPOSITPayments must accompany this hold form to secure spots. If your church prefers to send a check, and you chose, "mail a check to Tall Timbers," we must receive your check no later than 2 weeks from the submission of this hold form, or your spaces will be released. DEPOSITS ARE NON-REFUNDABLE. Credit Card Payment for Deposit*Card Details Cardholder Name Δ
