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Registration Information
room occupancy of 2-4 required for below prices
Ages 12-17
with a full registered parent
$60.00 due April 27th
*A late fee of $10.00 will be added after April 27th.
**Last day to register is May 18th.
Single room
occupancy for one
$160.00
One day attendance
$30.00
Retreat Fees are transferable, but non-refundable.
Registration covers meeting space, room, speaker fees and beverages.
More information, contact Vicki Gonzalez at 708-372-9468.
 
Please fill out the Registration Form only if your intention is to pay online using PayPal. Once you have filled out the registration form, you will be re-directed to PayPal's secured site to process payment. There you will be able to pay by credit card, or use your PayPal account.
  Form Mail Script 3.2
First Name *    
Last Name *    
Email Address *    
Address*    
City*    
State*    
Zip Code*    
Telephone Number*    
How many in your room?    
Status*    
Church Name    
Pastor's Name    
Name of roommates:    
     
     
     
     
     
        

* = Required fields



 
 

Cyvonne Davy
Tampa, Florida
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Dr. Janic Sjostrand
Newark, OH
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Caitlin Sjorstrand
Newark, OH
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