2012 Retreat Registration

Please fill-in all the fields, submit the information and then proceed to PayPal site for payment.

First Name: 

Last Name: 

Phone: 

Email Address: 

Confirm Your Email Address: 

Address: 

City: 

State: 

Zip Code: 

Food Restrictions:  Select from drop down None Vegetarian Diabetic Gluten Free

Church Home: 

Group/Table: 

   Please indicate who you'd like to be seated with - Maximum of 10 per table

How did you hear about us?:  Select from drop down Summer Postcard Brochure Mailer Family Friend Facebook Evite Church Bulletin Website Other

Have you been to retreat before?:  Select from drop down 1st Time 2-5 Times 6-10 Times 11-20 Times 21 Plus Times

Please indicate your age group?:  Select from drop down Under 21 21-30 31-40 41-50 51-60 Over 60