Navidad A Reynosa Team Leader Form

We are very excited to see what God is going to do this year at Navidad A Reynosa, and we are looking forward to seeing you. To confirm your reservation, please complete this form and submit a non-refundable deposit of $50 per person by October 15 to:

Upon This Rock International
906 West Acacia Avenue
Box 5114
Alamo, TX 78516

• Arrival date is December 27 between 10am and 1pm with lunch provided at 1pm.
• Departure date is December 30 by 10am with continental breakfast provided.
• Cost is $175 per person.

Group Information

Church/Group Name:

Address:

City:

State:

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Postal Code:

Leader Information

Leader Name:

Home Phone:

Cell Phone:

Email:

Other Information

Number of Males in Group:

Number of Females in Group:

Please list any medical concerns (including food allergies):

500 characters remaining.

Please list any special skills or talents on your team:

500 characters remaining.

Emergency Contact Information

Contact Name:

Daytime Phone:

Evening Phone: