Women’s Retreat Registration- 2020

Your Name (required)

Email (required)

Address (required)

City, State, and Zip (required)

Home Phone Number (required)

Cell Phone Number (required)

Emergency Contact Name (required)

Emergency Contact Phone Number (required)

Emergency Contact Relationship (required)

Special Medical Conditions we need to be aware of including allergies: (required)

Are you a nursing mom bringing a baby with you?

Will you require babysitting?

Are you a Night Owl or Early Riser?

Please list one other woman you would like to room with (required)

Would you like to provide scholarship money for another woman?

If yes, please fill in amount of scholarship


Your registration will be held once you have submitted the $25 non-refundable deposit (go to the “donate” tab on the home page). Cost is $140 per person (16 yrs. and over) before 2/23 and $150 after 2/22.