Registration
December 1-3, 2017 Leader Retreat
Leader/Leader Applicant Name *
Your answer
Phone number *
Your answer
Email address *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
How many people will be in your room including you? *
Name(s) of other adults in room:
Your answer
Name(s) and age(s) of children in room:
Your answer
Meals are served “all-you-can-eat” buffet style in the dining room. Please note any special food requirements:
Your answer
Special needs
Payment online or mail? *
Payment options ($50 deposit is nonrefundable) *
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