Please complete all applicable personal information:
Name
Mailing Address
City
State
Zip
Home Phone
Cell Phone
Date of Birth
Email Address
Home Church
Church Phone
Pastor's Name
Youth Pastor
If under 18, please complete applicable information:
Parent(s) or Guardian(s):
Home Phone
Parent's Cell Phone
Parent's Email Address
Parent's Fax
Please specify your shirt size - everyone attending SPTC 2010 will receive a Survivors T-shirt.
Select your size
If you are a member of a pro-life group in your area, please complete the following:
Name of group
City
State
Your level of involvement
How did you hear about Survivors? 
Please briefly describe your Christian life and experience. 
Please explain why you feel people of your generation should be actively pro-life.
I agree to the following:

Yes, I agree.

No, I do not agree

I am committed to serving Jesus Christ and to fighting against this American Holocaust known as abortion.  I believe that every child has been formed in God's own image and that each child possesses the right to life.  I am pledging to spend my time at Survivors Camp serving God by speaking out for those who cannot speak for themselves.  I agree to follow all rules and guidelines set by the Survivors Staff while participating in Survivors ProLife Training Camp 2010. 
  
 

Send $50 non-refundable deposit to:
Survivors - P.O. Box 52708 - Riverside, CA - 92517

To pay deposit online, use the online donation system
and write "SPTC 2010 Camp Deposit" in the Memo field before submitting payment.