Women's Psalm Retreat Registration: April 28-29, 2017
Please complete the following form to register for Women's Psalm Retreat, April 28-29, 2017 at Birchwood Camp.

If you have questions or problems with this registration form please call 688-2734 or email registration@birchwoodcamp.org.

Name
Your answer
Date of Birth
Your answer
Address
Your answer
City, State, Zip
Your answer
Email
Your answer
Phone
Your answer
Church (if any)
Your answer
Special Health Needs
Special Dietary Needs
When communicated in advance, we generally can provide menu items that will accommodate special diets. It is very important to indicate any food allergies. Please give us specifics in the space provided in the "other" section below.
Required
Do you have any other medical or health concerns we should be aware of?
These will be kept confidential.
Your answer
Emergency Contact
Your answer
Payment Information
Cancellations until April 15 will get a full refund. Cancellations after April 15 will get a 50% refund.
Please select the appropriate fee:
How will you be paying for this registration?
Credit cards are accepted on our website: www.birchwoodcamp.org; use the "make a payment" function on the left side. Checks can be mailed to PO Box 670049 Chugiak, AK 99567.
By submitting this form I agree to the following:
I recognize and acknowledge that camp activities can involve certain hazards, including, but not limited to illness, injury and accidents, and I hereby release Birchwood Camp and the Alaska United Methodist Conference from all liability.

I give permission for
-Photos/video to be used in future publicity
-Participant's name, address and email address to be shared with other registered participants and staff.

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