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Register for Equip

Equip Registration 2019

Please complete the following registration for Equip 2019.

1. Student Name (First):

2. Student Name (Last):

3. Date of Birth:

4. Gender:

Male
Female

5. Student Email:

6. Student Street Address:

7. Student City:

8. Student State:

9. Student Zip Code:

10. In the 2019/20 school year, this student will be a:

High School Freshman
High School Sophomore
High School Junior
High School Senior
College Freshman

11. Parent/Guardian Name (First):

12. Parent/Guardian Name (Last):

13. Parent/Guardian Email:

14. Parent/Guardian Phone:

15. Parent/Guardian Address (if different from student):

16. Church Name:

17. Church Address:

18. Name of Pastor:

19. School Name:

20. How did you hear about Equip?

21. Have you made your $100 deposit?

Yes
No

22. Will you need transportation to or from Logan International Airport?

Yes
No

23. Do you know anyone who may be interested in coming to Equip with you?