Individual Registration

Note: If you are attending with a church, you do not need to fill out this form.

General Information

Your Name *

Your Phone *

Your Address *

Your Address

Your Email *

Sponsor

Yes

Do you attend Mansfield Baptist Temple? *

Yes

No

Church you attend:

Remember: The event will not be at Mansfield Baptist Temple. It will be located on a field near the church. The address for this event is 998 Beal Road Mansfield, Ohio 44905.

Please contact Brandon Brater if you have any questions.
Church: 419-589-5413 Ext. 114
Email: bbrater@mbt.org

Total Cost

$

Payment Method *

Online (PayPal)

By Mail

At Event

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Waiver Form

IMPORTANT: Youth sponsors and teens are required to present a filled-out waiver to be allowed to participate in the Harvest Rally.

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