Pure Rebellion-Multiple Students (Same Family)

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Pure Rebellion Multiple Stiudents from Same Family

The form below is used to enter the registration for multiple students from the same family (no parent registrations. Enter information in all the pertinent fields, and click Submit at the bottom of the form

You will be forwarded to the payment screen.

Enter the following information:

Select Multiple Students from Same Family as the Type of Registration from the drop down list
Enter the Name of the Parent for payment reference
Enter the total number of student registrations being made

Click on Buy Now. You will then be forwarded to the PayPal screen for online payment for registration. PayPal is a secure site for online payment.

Registration for your students is not valid or complete until payment is made.

If this is not the type of registration you want, click RETURN to go back to the previous page.

You will be forwarded to the payment screen.

Enter the following information:

Select Multiple Students from Same Family as the Type of Registration from the drop down list
Enter the Name of the Parent for payment reference
Enter the total number of student registrations being made

Click on Buy Now. You will then be forwarded to the PayPal screen for online payment for registration. PayPal is a secure site for online payment.

Registration for your students is not valid or complete until payment is made.

If this is not the type of registration you want, click RETURN to go back to the previous page.

Pure Rebellion Multiple Students from Same Family


Student (1)

First Name*
Last Name*
Address*
City,State,Zip*
Primary Phone #*
Age (as of March 25)*
Male/Female*	Male Female
School Grade*
School*
email address
Church
Church City Location
Parent's Name*
Student (2)

First Name*
Last Name*
Age (as of 3/25/12)*
Male/Female*	Male Female
School Grade*
School*
Student (3)

First Name
Last Name
Age (as of 3/25/12)
Male/Female	Male Female
School Grade
School

Submit