Registration

Username

Password

First name

Last Name

Company (Optional)

E-Mail

Cell Phone Number

T-Shirt Size

Mailing Address - Street

Mailing Address - City

Mailing Address - State

Mailing Address - Zip.

Country, if not US:

Preferred Rappel Time I prefer to rappel in the morning
I prefer to rappel in the afternoon

Team Name I'd like to rappel individually
I'd like to create a new team -

I'd like to join existing team -

Donation Goal Amount

Desired Site Name

Registration Fee $100.00
Space Limited. Register Now!

Credit Card

Card Type:

Credit Card Number:

Credit Card Expiration (mm/yy):

/

Name On Card:

CVV Value:

Billing Address

Same as mailing address

Address:

City:

State:

Zip Code:

Country, if not US:

Yes, I would love to hear stories of hope and healing at Gracehaven! Please send me your monthly newsletter.

(Optional) In order to ensure my participation in Over the Edge on June 17th for Gracehaven, a division of Central Ohio Youth for Christ (COYFC), I hereby agree to allow COYFC to charge my credit card on September 18th if I am not at the fundraising minimum of $1,250.00 to guarantee my spot, the difference will be charged to my card and the maximum amount I may be charged is $1,250.00.

I hereby give permission to Central Ohio Youth for Christ (COYFC) to take event day photos of my likeness and use them in their promotional materials.
I understand that in order to rappel I will have to sign a waiver form on event day.

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