First Name * PERSONAL INFORMATION Last Name * Home Address * City * State * - - Choose One - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code * Home Phone Mobile Phone * Email Address * DOB (mm/dd/yyyy) * EMERGENCY CONTACT (Mandatory) Emergency Contact Full Name * Emergency Contact Phone * Relationship (ex: Mother, Father, etc.) * ACCOMMODATION TYPE (Mandatory) Room Type * Quad Rate- $899.00 Triple Rate $999.00 Double Rate $1,100.00 Single Rate- $1,350.00 BEDDING - 1 King or 2 Doubles * ENTER PROMO CODE * ROOMMATE(S) Roommate #1 Roommate #2 Roommate #3 Roommate #4 MISCELLANEOUS Bus Depature Location T-shirt Size * SM M L XL 2XL 3XL AMBASSADOR * CITY2CITY SOCIAL CONNECTIONS TWINS & FRIENDS BIG GRIM ENT ADULT BLACK SOCIETY KEEPEM CUMMIN ROOTS OF BROOKLYN JANE DOUGH ARMY MILES WILLIAMS CSTORM GETJETFIT I authorize City2City to process and accept my registration for the 2027 Soul on Ice Winter Escape Electronic Signature * Date (mm/dd/yyyy) * Security Code *