Please complete all fields; write "N/A" when unapplicable.
Personal Information
Name
Mailing Address
City
State
Zip
Home Phone
Cell Phone
Email Address
Gender
Date of Birth
Age on June 21, 2012
If under 18, please complete the following:
Parent(s) or Guardian(s):
Home Phone
Parent's Cell Phone
Parent's Email Address
Parent's Fax
If you are attending camp with a group, please give the group name to qualify for a group discount  
Shirt Size
 Everyone attending SPTC 2012 will receive a Survivors T-shirt.
Select your size
Have you attended any prior Survivors Camps?
If so what year(s)?
If you are a camp veteran (attended a prior year), you are not required to fill out the fields below. Skip to the commitment agreement and choose "Yes" before submitting your application.
Christian Background
Home Church
City, State
Church Phone
Pastor's Name
Youth Pastor
Please briefly describe your Christian life and experience. 
If you are a member of a pro-life group in your area, please complete the following:
Name of pro-life group
City
State
Your level of involvement
How did you hear about Survivors? 
Please explain why you feel people of your generation should be actively pro-life.
Camp Commitment
 

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 2012. 
Yes, I agree.
  
 

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

Completed applications and $50 deposit must be received by May 1 in order to receive the $75 Early Bird Discount.

To pay deposit online, use the online donation system
and write "SPTC 2012 Camp Deposit" in the Memo field before submitting payment.