Northpoint Experience: Leader Registration Form

First Name *

Last Name *

Phone *

Email *

Church Name *

Address

Church Address *

City *

State *

Days/Nights Staying *

Would you prefer to stay in the dorms or Academy Hall? *

Dorms

Academy Hall

Do you prefer a room to yourself? *

Yes

If no, Please list the names in your party. If you’d like to bunk with your group, it's girls with girls, guys with guys.

Do you have any allergies? *

Emergency Contact Name *

Emergency Contact Number *