Adult Scholarship Application

If you encounter issues submitting the online form, download the application here: Adult Scholarship Application

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Are you 19 years of age or older? *

Yes No

Church Name *

Church City & State *

Is this your first conference at Green Lake? *

Yes No

Conference Attending *

Arrival Date (Month/Day/Year) *

Departure Date (Month/Day/Year) *

Confirmation Number *

Where are you staying? *

Group Leader's Name (if applicable) *

Group Leader's Phone Number *

Submit