UMW: CCC Puzzle Exchange Dinner

Christian Conference Center

Puzzle Exchange Dinner

Every individual that plans to attend must complete a registration form. If you have any questions, please contact Crystal at 515.367.0440 or [email protected].

Attendee Information

Name*

Date of Birth*

Address*

Phone Number*

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. Reply STOP to cancel. View our terms of service & privacy policy.

Email*

Phone and email may be used for communication purposes.

Allergy Information

Allergy Information*

No known allergies
Tree Nuts
Nuts
Gluten
Shellfish
Red Dye 40
Other Food
Medicine
Environment
Other

Please describe what the attendee is allergic to, the reaction seen, and how it is treated.

Diet/Nutrition

Diet/Nutrition Needs*

This attendee eats a regular diet.
This attendee eats a gluten-free diet.
This attendee eats a vegetarian diet.
This attendee eats a red-dye 40 free diet.
This attendee has other special food needs.

Please describe any special food needs.

Payment

Puzzle Exchange Dinner*

Puzzle Exchange Dinner ($15.00)

***Each person attending must fill out a registration form!***

Kids three and under eat free! Use the coupon code UNDER3.

Coupon Code

Total

$0.00

Authorization Information

By signing you agree to the responsibility and supervision of your participants and yourself. CCUM/CCC is not liable for any loss, damage, injury, or claims arising out of participants' acts or omissions.

By typing my name here, I accept these terms.*

Do we have permission to use the camper's photograph in online or print publications, or in social media by the CCC and/or the CCUM?*

We are able to keep our events affordable because of donations from generous supporters. Every gift helps us fulfill our mission to provide a safe, welcoming experience to as many people as possible. Thank you!

Donation Amount

Suggested Amounts

$5
$10
$15
Other Amount

Add 3% to my donation to cover credit card fees.

Total

$0.00

Billing Information

Email*

Name*

Credit Card*

Visa
Mastercard
American Express
Discover

Address*

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