TB Midland 2007 Registration

       July 9 - 15, 2007

Instructions:
    The following is a form you may fill out for registration.
    When you press the "next" button at the bottom of the page, all the data you wrote will be sent to the Secretary at Trailblazers. You can contact the secretary (see contact info below) later to correct any information. We do not share our information with anyone for any reason; privacy policy pending.
    The next page will allow you to submit your non-refundable down payment of $150. The remaining $400 will be due in full on or before May 28, 2007. Only when you submit your down payment will you be considered officially registered.
    All of these fields are required fields.

* Tell us your full name (first, middle and last):
* Of which nation are you a citizen? (E.g.: USA, Mexico, Canada, France…)
* What is your birth date? (Use Month/Day/Year format, please.)
* Street Address:
* City:
* State (two letters only, please):
* Zip Code:
* Home Phone:
* Cell Phone (write "none" if you don't have one):
* Email Address:
* What Parish are you from? (include parish name, city, and state, please)
* If you traveling with a youth group or parish, tell us who, or otherwise just write "none":
* What is your T-Shirt size (S-XXL)? (Write one of these: S, M, L, XL, XXL)