Chambers Faith Quilters
Registration Form
This form is for the following Retreat *
First Name *
Your answer
Last Name *
Your answer
Street Adress *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Room Mate Request. (Please note this is not guaranteed)
Your answer
Please check all that apply. *
Required
I will be coming for the following times. *
How will you be paying for the event? There are scholarships available. *
I grant Chambers Camp & Retreat Center the right to take, print, and/or electronically use photographs/videos of me and/or my child in connection with camp activities for such lawful purposes as publicity, illustration, advertising, and web content. *
Required
Please Make Checks Payable to:
Chambers Faith Quilters
Please Send Checks to:
Patti Robinson
191 Moyle Ln.
Wyalusing, PA 18853.
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