Registration Form

Women on Mission Annual Retreat
August 24 – 25, 2018

Shocco Springs Baptist Conference Center
1314 Shocco Springs Rd., Talladega, Al

Please make all checks payable to Sixth Avenue Baptist Church
No REFUNDS after August 12

DOWNLOAD FULL HAND OUT

TO REGISTER: COMPLETE THE FORM BELOW

Enrollment Date*
- Fall
- Spring
Current Enrollment
Please list the college or university where you are currently enrolled if applicable.
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Date of Birth*
MM slash DD slash YYYY
Age
Sex
- Male
- Female
Home Phone
Cell Phone
Email*
Are you a member of Sixth Ave Baptist Church?
- Yes
- No
What is your church membership #
In what church ministries are you actively enrolled?
List of public service and community activities for which you where an active participant.
List of school related activities
School and Academic Achievements
Attachment documentation to each community service organization
Drop files here or

Max. file size: 64 MB.
Parent(s) or Guardian(s) Name(s)
High School Name
Expected Graduation Date
Recommendation Form
Max. file size: 64 MB.
Your photo for media use
Max. file size: 64 MB.
Please include a photo of yourself to use for our slideshow, website, or social media posts to celebrate your accomplishments.
All other necessary uploads for your application
Max. file size: 64 MB.