RA Congress Hold Form 2021 Dates: April 9-10, 2021 COVID Restrictions - limited to 50% capacityDid your church attend Tall Timbers for RA Congress OR attend Tall Timbers for summer camp before this year?*YesNoChurch Name*Church Billing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Church Phone*Church Email (if no email, type none)*Church Name,City,State*Are you a NEW contact person registering this church?*YesNoPrimary Contact Name*Your gender:*MaleFemalePermanent Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Church Employee or Church Contact?*Church EmployeeChurch ContactYour Title:Date of Birth (to avoid duplicate names in online system)*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Primary Cell Phone*Your Name*Your Cell Phone*Email* How many spots are you reserving for RA Congress?*You must 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 formMail a check to Tall TimbersNumber of male chaperones (age 21 or older)* Price: $10.00 Quantity: $25 per person program fee, $10 deposit charged per person todayNumber of male jr. counselors (age 13 to age 20)* Price: $10.00 Quantity: $25 per person program fee, $10 deposit charged per person todayNumber of Lads (completed grades 1st-3rd)* Price: $10.00 Quantity: $25 per person program fee, $10 deposit charged per person todayNumber of Crusaders (completed grades 4th-6th)* Price: $10.00 Quantity: $25 per person program fee, $10 deposit charged per person todayTotal people in your group:Total for Credit Card payment today ($10 per person) $0.00 Program Fees Total PriceNumber of male chaperones (age 21 or older)*$25 per person program feeNumber of male jr. counselors (age 13 to age 20)*$25 per person program feeNumber of lads (completed grades 1st-3rd)*$25 per person program feeNumber of crusaders (completed grades 4th-6th)*$25 per person program feeTotal people in your group:Program Fees total priceLODGING*Lee Lodge and Indian Creek rooms not available this year*Are you staying overnight (Friday to Saturday) at RA Congress?*Yes, I need overnight lodgingNo, my group will commuteChoose which lodging you prefer for your group:*Cabins: bunk-style, no linens: $27 per personDo you need a private or double room arrangement? (Private or double rate is higher than standard $27 per person charge)*YesNoDo you have any special housing needs?Choose the days you will commute to RA Congress:*We are coming Friday only ($5 per person)We are coming Saturday only ($5 per person)We are commuting both days ($10 per person)Number of persons in Lee Lodge?*$27 per personNumber of persons in cabins?*$27 per personNumber of people commuting Friday*$5 per personNumber of people commuting Saturday*$5 per personNumber of people commuting*$10 per personTotal price for Lodging/CommutingMeals and Additional ChargesWhich meals will your group eat with us? Check all that apply* Friday supper Saturday breakfast Saturday lunch Are you adding t-shirts to your group charge? ($10 per person)YesNoPlease list # of persons eating Friday supper*$8.75 per personPlease list # of persons eating Saturday breakfast*$8.75 per personPlease list # of persons eating Saturday lunch*$8.75 per personPlease list # of t-shirts needed (sizes will be asked later in the registration process)*$10 per personTotal price for Meals/T-shirtsEstimated Total for RA CongressDeposit Owed Today ($10 per person):This will be applied toward the total price.Deposit Owed Today ($10 per person):This will be applied toward the total price.Please choose one security question of your choice for us to set up your online registration and provide the answer below:*What is the name of the city in which you were born?What is the name of the elementary school you attended?What is your favorite color?What is your mother's maiden name?What is your pet's name?Answer:*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. Payment today is for deposit only ($10 x total number of people)Credit Card Payment for Deposit* Card Details Cardholder Name
