SURVIVAL DAZE provides a great atmosphere for

creating friendships and getting to know new people!

First Name: Last Name: Permanent Home Address: Address: City: State: Zip: School Address: Address: City: State: Zip: Email Address: Phone Number: Cell Phone Number: Class: Freshman Transfer T-Shirt Size: Small Medium Large X Large XX Large Send us a Message if you would like: Please send $30 registration fee to BCM, 1522 N Oak St, Valdosta, GA 31602