IBC Ladies Retreat
Fill out the form below to attend the IBC Ladies Retreat, January 18-19, 2019. Please be sure to follow the link at the bottom to pay the registration fee. Shirt registration deadline January 2nd, 2019; deadline for no shirt ordered will be January 11, 2019.
Email address *
Full Name: *
Your answer
Address: *
Your answer
Cell Phone Number: *
Your answer
Can we send you text messages? *
Select one: *
If you choose to purchase a sweatshirt, what size do you need?
Please indicate transportation to Falls Creek: (Departure time: 5:30pm, Jan 18th) *
Special Concerns: (Including request for 1st floor room)
Your answer
Payment Method
Please let us know how you will pay.
Will you pay online or in the office? *
IN CASE OF EMERGENCY
Please fill out all emergency contact information below:
Emergency Contact Name: *
Your answer
Relationship: *
Your answer
Emergency Contact Phone: *
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Immanuel Baptist Church. Report Abuse - Terms of Service