St. Mark's Youth Junior and Senior Retreat Deposit
Please fill out this form and click submit.
Dates: June 22-25
NC Mountains
Youth Name
*
Parent/Guardian Name
*
Email
*
This address will receive a confirmation email
Phone
*
Payment
$152.00
You understand there is 1 deposit per youth
*
Please select all that apply.
Yes
You understand this deposit is non-refundable
*
Please select all that apply.
Yes
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
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
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NE
NH
NJ
NL
NM
NS
NT
NU
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NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
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SD
SK
TN
TX
UT
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VI
VT
WA
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WV
WY
YT
Submit
Description
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