2017 Mother-Daughter Retreat
Please fully complete registration form. If you have any questions, please call the Agapé office at 919-552-9421.

If you are having trouble moving between fields on the form, use the "tab" key to navigate to the next section.

After submitting this registration form, you will be offered a link to pay online via credit/debit or a check can be mailed to Agapé. Checks can be made out to "Agapé Kure Beach Ministries" and mailed to 1369 Tyler Dewar Ln, Fuquay Varina, NC 27526

Name
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Email
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Phone Number
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Additional Phone Number
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Address
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City, State
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Zipcode
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Home Church
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Other participants names' listed
Please put children's ages after names or designate as adult
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Number of Participants under age 3 (free)
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Number of Participants ages 3-12 ($60)
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Number of Participants over age 13 ($90)
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Special needs or dietary concerns
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