Request edit access
2019 Virginia Camp and Retreat Leaders Gathering
Please fill out one registration form per person; thank you!

All overnight participants will be housed in the Burrows Retreat Center. Description, photos, and layout can be found here: http://www.altamons.org/accommodations.html

For questions or more information, please contact Meredith at 540-268-2409 or office@altamons.org
Participant Information
First and Last Name *
Your answer
Camp/Retreat Center: *
Your answer
Mailing Address (Street/PO Box, City, State, Zip) *
Your answer
E-mail *
Your answer
Phone Number *
Your answer
Registration Type: *
Roommate Request
Your answer
Your Gender
Your answer
Dietary Restrictions & Allergies
Please list all allergies and dietary restrictions (vegan, gluten free, etc.) *
Your answer
Emergency Contact
Please list a name and phone number for an individual to be listed as your emergency contact during this gathering.
Name *
Your answer
Phone Number *
Your answer
Photo Permission
Please type your name to acknowledge the sentence below.
Photo Permission I give permission for photos of conference activities to be used in camp promotional or newsletter materials without liabilities or remuneration. *
Your answer
Payment
Please indicate how you would like to pay for this event. *
Please type out the name as it appears on the credit card you are paying with (if you are paying by credit card)
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of UVa. Report Abuse - Terms of Service