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June 11-13, 2021 Registration

- RETREATS & PROGRAMS

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- Retreatant Information:
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Please List Any Allergies:
- Room Location Preference: REQUIRED First Floor Second Floor No Preference Please fill out this field.
- Room # Request (if applicable): Please enter valid data.
- Suite Mate Request (if applicable): Please enter valid data.
- Emergency Contact Information:
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Phone #: REQUIRED Please fill out this field. Please enter a phone number.
- Relationship to Retreatant: REQUIRED Please fill out this field. Please enter valid data.
- Retreat Payment:
- A non-refundable $100 deposit is required to secure your registration and will be applied towards your final payment. The payment in full includes the $100 deposit.
- Retreat Payment: REQUIRED 100 – Deposit Only 350 – Full Payment Please fill out this field.
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Optional Donation Opportunities:

All donations received above the full cost of your retreat are considered tax deductibe. Donations that go towards our Maintenance Fund specifically help us with the upkeep and maintenance of our building and grounds. General retreat donations above the cost of your retreat often help to provide the opportunity for those who otherwise would not be able to attend a retreat due to financial difficulties the chance to attend a retreat. Thank you for supporting our ministry and for your generosity!

MAINTENANCE DONATION

RETREAT DONATION

June 11-13, 2021 Registration

Retreatant Information:

Emergency Contact Information:

Retreat Payment: