Group Registration

Group Registration Form for Momentum 2012

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To Register your group for Momentum 2012, please be sure to fill out all of the information below. If you are registering more than 5 students, please fill this form out more than once.
Please note: Due to housing limitations, we are unable to house groups in the residence facilities. Groups are encouraged to secure overnight housing through the following recommended hotels:

Marriott Residence Inn

Hampton Inn

Please complete the following:


Leader's First Name:

Leader's Last Name:

Leader's Phone Number:

Leader's Address (Please be sure to fill in your complete address including city, state and zip):

Leader's E-mail Address:

Name of Group or Church:

Group/Church Phone Number:

First and Last name of students attending


Lodging Needed:
Any Additional Information:

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