Set Up a Road trip - 2022

Name of CTeen Chapter*

Name of Chapter Director*

Email*

Phone number*

Starting location*

Places to be visited during the trip*

Starting date of trip*

Ending date of trip*

Number of days*

Number of nights*

Number of boys estimated to participate and grades?*

Number of girls estimated to participate and grades?*

How much will you be charging each participant?*

We assist you with billing via Authorize.net - Please provide your ADN Login ID

Please provide your ADN Transaction Key

Three sentences about/describing the Road trip *

Please list some of your road trip's activities and features*

(cteen merch and tshirts are sent out 1.5 weeks before trip date; sign ups any later will not be applied)

What is your refund policy/deadline?*

Comments

Road Trip Payouts:

What Moised do you want your check made out to?*

What address would you like your check sent to?*

Address Line 1

Address Line 2

City

State

ZIP Code