Registration

Registration Options

Student ($50.00)

(The total cost for this program is $850 per person, but we're asking for $50 to secure your spot. The rest will be fundraised as a group by the start of the trip in June.)

Contact Information

Name

Confirm Email

Yes, please send me updates and opportunities related to InterVarsity’s ministry.

Phone Number

May we text you at this number for event related updates, onsite emergencies, etc.?

Mailing Address

Address

Emergency Contact Information

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Medical Insurance: Are you covered by a Medical Insurance policy?

Demographics

Date of Birth

Gender

Male
Female
Prefer Not To Identify

Gender

Additional Questions

What drew you to the Eloheh Justice Program?

What knowledge/experience have you had in Native cultural spaces? (If none, that's fine!)

Trip Costs and Fundraising

The total cost of this program is $850 per person. For some of our participants, that cost is not a barrier, but others need to fundraise to cover the cost. As a Justice Project learning about harmony and equity, we're inviting everyone attending Eloheh to participate in fundraising as a community.

About how much do you think you will be able to contribute to your program costs?

Would you be able to commit to 2-3hrs/week of fundraising work in the month of May to help the team get to Eloheh this June?

Yes
I'm not sure. I would like a staff to reach out to me so I can learn more.

Individual Release/Waiver

Individual Release/Waiver | Version 10.22.2020

I have read and agree to the terms above.

Should the PDF not display properly, you may download a copy of the Individual Release-Waiver_10.22.2020.pdf

Running Total

$0.00

Coupon Code

Total

$0.00

Billing Information

Name

Use a previously saved card

Credit Card

Visa
Mastercard
Discover

Save this card for future use