Northeast Community Church | Fishers, Noblesville, Pendleton, Indianapolis, Indiana

Forms

Please complete the following form:

First Name
Last Name
Mailing Address (city, st and zip)
Preferred Phone Number
Email Address
Room Selection
	Information Note: Registration fee includes accommodations for Friday and Saturday night, three meals on Saturday and breakfast on Sunday. Friday night dinner is on your own.
Do you wish to request specific roommates?	Roommate(s) requested:
I would like to make a contribution to the Women’s Retreat scholarship fund to help other women attend.	Scholarship Donation Amount: Please add the cost of your room selection, plus any donation to the scholarship fund with your payment.
I would like to request vegetarian meals.
Please indicate any food allergies we need to consider.
Payment and Cancellation Policy	Payment may be made by check or debit/credit card. Cancellations will be accepted until April 7, 2010 at midnight. Cancellations must be made in writing (email to dianagarino@aol.com) and refunds will be less a 5% processing fee. Due to our contract with the conference facility, there are no refunds for cancellations after April 7, 2010. Registrations may be transferred to another individual until April 23, 2010.
Payment Options	Checks - must be made payable to Northeast Community Church, and must be received within 10 days of registration. Debit/Credit Cards - To complete registration when paying by debit / credit card, you must complete payment via the online form listed below: Online Payment Form