Women's Retreat Registration

Retreat Registration


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Women's Retreat Registration (Cost - $225) non-refundable
Retreat Dates: 12-19-2019(Thursday) 8 AM - 12-21-2019(Saturday) 4 PM
Final Registration and Payment Deadline:10-20-2019
Early Registration and Roomate Selection Deadline: 09-15-2019
Camp Allen Conference & Retreat Center

*required fields 

 

Personal Information

 Transportation

First *

Middle

Last*

Jr/Sr

Age*

How will you get to the retreat site?*

Bus
Personal Vehicle

Name*

Address*:  

   

 

 

City*

       State*:         Zip*:

  Other:
Other City:

Home

Work

Cell

  Special Needs
Please list any special needs, diets, or accommodations you require.
*

Please check if you need a handicap accessible room.
Other
:*

Phone #*:

--

--

--    

Email*:

Verifcation sent. Must be valid email address.   

 Verify*:

Alt Email:

Verifcation sent. Must be valid email address.      

Medical Information
Please specify any medical conditions that maybe a
concern during the retreat.
*

Diabetec Blood Pressure 

Heart Condition  Asthma  None
Other:
 

Verify:

Emergency Contact Information 
First* Last* Relationship*

Name*:

Phone #*: --

Marital Status

Married/Engaged?
*:  Yes:  No:            How many years?

Please list any medications or substances that you are allergic to.*

 

Membership Information
Are you a member?
*Yes    Are you a member?*No           Is this your 1st Retreat?  Yes   No

Which Location are you a member or guest of?*

                                              Baton Rouge
                                             
Beaumont
                                             
Bryan
                                             
Dallas
                                             
Houston
                                             
Lafayette
                                             
Lake Charles
                                              Monroe
Please list any medications that you will take during the
retreat.
*

T-Shirt Size:*

Small         Medium   Large

XL            XXL        XXXL

XXXXL  

 

 

Are you an invited guest?        Yes 

Who encouraged you  to  attend?
First Name:
     Last Name:

 


What day will you arrive at the retreat site?
Thursday         Friday         Saturday 

Leadership Information (Please check all that applies to you)
Are you a Pastor?Yes    Assistant Pastor?Yes  Are you a Pastor's wife?Yes  Pastor's Assistant?Yes
   Teacher?
Yes 
Other?
Please Specify:           

Parental Consent Information (
Required for those youth under 18 years old)
 

Please list any topics you would like to see addressed at the retreat.*

    

 Check box here if same as Emergency Contact Information above

First* Last* Relationship*

Name*:

Phone #*: --