Midwest Winter College Retreat 2019 Registration Form
Hello everyone!

The Midwest Winter College Retreat is coming up next semester on January 18-20, 2019 at Camp Tecumseh. We would like to encourage all of you to register and pay ($100) by the deadline set by your campus staff.

WHAT: Midwest Winter College Retreat 2019
WHEN: January 18-20, 2019 (Friday 7 pm to Sunday 12 pm)
WHERE: Camp Tecumseh (12635 W. Tecumseh Bend Rd., Brookston, IN 47923)
COST: $100

First Name *
Your answer
Last Name *
Your answer
Gender *
Phone Number *
Your answer
Which city are you closest to? *
Email *
Your answer
If other, please indicate which city you are from:
Your answer
What state are you in? *
List any allergies (food, medicine, etc.) *
Your answer
Emergency Contact *
Your answer
Emergency Contact *
Emergency Contact's Phone Number? *
Your answer
Will you attend full-time or part-time? *
Will you drive a car there? *
How many people, including yourself, can you take?
Your answer
If you know who will be driving with you, please indicate the names of those that are coming with you below:
Your answer
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