Women's Retreat Registration Form

Please complete the following form:

First Name
Last Name

Mailing Address
(city, st and zip)
Preferred Phone Number

Email Address

Fee:
 

Information Note:

Registration fee includes breakfast and Lunch.

I would like to make a contribution to the Women’s Retreat scholarship fund to help other women attend.

Scholarship Donation Amount:

Please add 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 May 1, 2011 at midnight. Cancellations must be made in writing (email to rjemmerson@sbcglobal.net) and refunds will be less a 5% processing fee.

Payment Options

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

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