Name *

First Name

Last Name

Student's Phone Number *

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address

(Leave blank if it's the same as home address)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender *

Male

Female

Birthday *

MM

DD

YYYY

T-Shirt Size *

X-Small

Small

Medium

Large

X- Large

2x- Large

3x- Large

4x- Large

I give permission to TEC Central California to share my contact information with other students and leaders after TEC to stay in contact *

Yes

No

By submitting this application, you agree to pay the fee of $40 to the Teens Encounter Christ organization. All payments are due at time of submission. If you need financial assistance, please contact a member of the TEC Board. *

I agree to pay the $40 fee