Adult Retreat Registration Form

Retreat Attending:

Spring Scrapbook Retreat (March 9-11, 2012)

Women's Retreat (September 14-16, 2012)

Fall Scrapbook Retreat (October 19-21, 2012)

Men's Retreat (November 9-11, 2012)

Name:

Address:

City:

State:

Zip Code:

Phone Number:

Email:

Special Needs/other (mobility, dietary):

Retreat Fees:

Retreat with Lodging ($130)

Retreat without Lodging, or RV/Tent ($75)

Special Rate: Fall Scrapbook Retreat ($115)

Requested Lodging:

Requests will be noted but can not be guaranteed.

Roomate Request:

I hereby certify that the above information is accurate and I give my permission for the use of photgraphs and videos of me to be used for camp publicity (type your name below in place of a signature):