KCSC Road Trippers Registration Form

KCSC Road Trippers' Registration Form

Please fill out the below form to register for one of our upcoming road trips! This is a new opportunity for older adults who want to travel with likeminded and similarly aged people. The KCSC Road Trippers' will offer day trips and regional travel experiences designed with lifelong learners in mind — those who want to learn about our destinations and experience new adventures in a group setting. Over time, KCSC will offer a variety of trip lengths and pricing so you can find one that fits your calendar and unique interests.
The cost per person for this trip is $75. You can pay online (you will be redirected to the online donation page after you complete this form), or you can write a check and mail it to our offices at the address below. Please put "Road Trip" in the memo line.

KC Shepherd's Center

9200 Ward Parkway

Suite 200

Kansas City, MO 64114
October 4, 2023

Atchison, KS
Name of Traveler (Please fill out a form for each traveler seperately):*

First NameLast Name
Are You Traveling Alone or With Someone?
If Traveling With Someone, Please Provide Their Name Here:
T-Shirt Size (PLEASE NOTE: Only select a T-shirt size if you do not already have a RoadTrippers shirt from our previous trips).
Phone Number*
Please enter a valid phone number.
Phone Type*

CellHomeWork
Email:
example@example.com
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Person:*

First NameLast Name
Emergency Contact Phone Number:*
Please enter a valid phone number.
Please describe any medical concerns or disabilities that you wish to share:
Thank you for registering! Please leave any comments or questions you may have below.
SCPSch

Yes
Should be Empty:

KCSC Road Trippers' Registration Form

October 4, 2023