Great Escape 2024

Great Escape 2024!

Great Escape is a fantastic opportunity to make new friends, hang out with old friends, get to know Jesus better, and have some awesome fun in the beautiful New Mexico mountains!

*NOTE - Once registered, you will also need to complete the Glorieta Waiver. Instructions will be included in your confirmation message & email. Please take care of this right away! Thank you!*

Location Information

Location Name
Glorieta Adventure Camps
Address
11 State Route 50, Glorieta, NM, 87535 US
Directions
Google, Bing, MapQuest

Registration

Registration Options*

Student ($170.00)
Staff ($170.00)
Other ($170.00)

Contact Information

Name*

Email*

Confirm Email*

Yes, please send me updates and opportunities related to InterVarsity’s ministry.

Phone Number*

May we text you at this number for event related updates, onsite emergencies, etc.?*

Mailing Address

Address*

Emergency Contact Information

Emergency Contact Name*

Emergency Contact Relationship*

Emergency Contact Phone*

Medical Insurance: Are you covered by a Medical Insurance policy?*

Dietary Concerns*

Demographics

Date of Birth*

Gender*

Male
Female
Prefer Not To Identify

Ethnic Identification (check all that apply):*

Black/African Americans
East Asian Americans
Hispanic/Latino Americans
Middle Eastern Americans
Native Americans/Alaska Native/First Nations
Native Hawaiian/Polynesian/Melanesian/Micronesian
South Asian Americans
Southeast Asian Americans (Include Pilipinos)
White/Caucasian Americans
Bi racial/Multi Racial (Include any counted in the other ethnic categories.)

College / University Information

Graduation Year*

College / University Name*

Individual Release/Waiver

Individual Release/Waiver | Version 10.22.2020*

I have read and agree to the terms above.

Should the PDF not display properly, you may download a copy of the Individual Release-Waiver_10.22.2020.pdf

Glorieta Waiver

*NOTE - Once registered, you will also need to complete the Glorieta Waiver. Instructions will be included in your confirmation message & email. Please take care of this right away! Thank you!*

Running Total

$0.00

Coupon Code

Total

$0.00

Billing Information

Name*

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Credit Card*

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Address*

Email*

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