Youth Ministry Camp - Center FUGE 2025
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First and Last Name
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Email
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Phone
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Address
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Gender
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Male
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Grade
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6th
7th
8th
9th
10th
11th
12th
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6th
7th
8th
9th
10th
11th
12th
Payment
Deposit ($150.00)
Total Price ($250)
Deposit ($150.00)
Total Price ($250)
Amount
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
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AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
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