Jesus People USA
Group Visitor Form
Fields marked with * are not required.

Name of Organization, School or Church

Address

City State ZIP

Contact Person

Work Phone

Home Phone

Cell Phone*

Email

Proposed Dates of Visit
Choice #1 
Choice #2 
Choice #3*

Total # of Guys Girls

Age Range of Group

Daily Fees
Room and board fees are $20 per person per night.

Number of Persons in Group x Nights x $20

Deposit
Deposits are as follows:
February to April (Spring Break): $200.
From June through August (Summer): $300.
Deposits for the rest of the year are $100 dollars per group.
Please don't send in your deposit until you have confirmed your dates with us either by phone or email. The deposit will be subtracted from the overall expense.

Accompanying Group Leaders*

  Name Cell Phone M/F
1.
2.
3.
4.
5.

How are you traveling?*

Estimated time of arrival*

Are there any medical or physical special needs among the group that we should be
aware of?



Comments / Questions?*

Before pressing "SUBMIT" Please print this form so that you may have a copy for your records.

IMPORTANT INFO: Contact our office with your proposed visiting dates. Spring and Summer groups typically book from a Monday night through a Sunday morning to make room for the maximum number of groups. Once you have tenatively set your dates with us, you should send this form in as soon as possible, along with your deposit, to secure your dates. Feel free to call, email, or write us with questions and for further information.

We look forward to hearing from you and serving with you!

Scott Ingerson and Brach Siemens
Youth Group Coordinators
Jesus People USA
920 W. Wilson
Chicago, IL 60640

The Youth Group Office may also be reached by calling (773) 303-4064
Our fax is (773) 989-2320.

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