D48 Registration

KIUMC

Are you ready to dive into D48?

Sign up using the form below, and our D48 coordinators will contact you shortly. For more information, email D48@kiumc.org.

* Indicates required field

Name *

First

Last

Address *

City *

State *

Zip *

Email *

Age Group *

18-29 30-39 40-55 55+

Phone *

Are you joining as a: *

Single Couple Family

Would you be willing to serve as Lead Host for your group? *

Yes No

Do you have any food or pet allergies? *

Food Pet Other

Please specify: *

Would you prefer: *

Adults only Children included, to be seated at a children's table No preference

Additional comments: *

Submit

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