Palmer Women's Retreat 2019 Registration Form - Waitlist Signup
January 25 - 27, 2019 at Camp Allen
Name for Badge
Are you a Palmer member?
Emergency Contact Name
Emergency Contact Relationship to You
Emergency Contact Phone Number
Special Dietary Needs
Lodging Options and Fees
Please match me with a roommate. ($200 registration fee)
I would like a single occupancy room ($300 registration fee). NOTE: We have a limited number of single occupancy rooms available. Singe rooms will be filled on a first-come, first-served basis.
I am rooming with another woman and I have already checked with her. ($200 registration fee) NOTE: Please be sure your roommate registers as soon as possible to ensure that we can honor your request to room together.
Name of Pre-selected Roommate (if applicable)
I would like to speak to someone about receiving a scholarship. Please contact me.
Scholarship Donations (I am including the following amount in my payment to help someone attend the retreat.)
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