Living Lands and Waters -Xstream Cleanup in Lousiville, KY

Calendar | General Liability Release

PLEASE PRINT THE GENERAL LIABILITY RELEASE FORM ABOVE
READ, SIGN AND BRING TO THE EVENT TO VOLUNTEER

On-line Registration form for Alternative Spring Break

Please fill out and submit the form below. We will contact you via the email address you list, unless otherwise noted. You will receive an email to verify that we have received your registration and payment. Please note this event is only open to college students and there will be no refunds once students have registered.

*Denotes a required field.

*Name:
*Email:
Alternate Email:
*Address:
*City:
*State:
*Zip:
*Primary Phone:
Secondary Phone:
Work Phone:
*College Attending:
*Select ASB Event Week:
Group Leader:	Yes No
	If yes, how many group members will be joining you? (PLEASE INCLUDE YOURSELF, THE GROUP LEADER, AS PART OF THIS NUMBER)
Organization/ Affiliation:
Special needs/Comments/Rooming Requests:
	* Type in the text from the left:
	CONFIRM REGISTRATION BY PAYING FOR YOUR LODGING (ON NEXT PAGE)

FOR MORE INFORMATION:

Shanon Reineke, Programs Coordinator, Living Lands & Waters
Email:shanon@livinglandsandwaters.org
Phone: 309.236-5627

Greg Boll Photography,
Photographer for LL&W