2019 Women's Retreat Registration
Registration for the 2019 Shawnee Church of the Nazarene Women's Retreat - April 12-14, 2019
Who is registering? (first & last name) *
Your answer
Home address (Street, City, Zip) *
Your answer
Mobile Phone # *
Your answer
Email address *
Your answer
Emergency Contact (name) *
Your answer
Emergency Contact Phone Number *
Your answer
Please list any physical conditions and/or current medications & doses we should be aware of during this event:
Your answer
Please list any dietary restrictions you have (gluten allergy, etc):
Your answer
Do you have a skill/talent/interest that you would like to share during Saturday free time?
If yes, please describe here:
Your answer
Room Options (please choose one) *
For double occupancy rooms, please list one or two other women you would like to share a room with or list "no preference":
Your answer
Do you want to carpool with other women? *
Are you willing to drive other women to retreat? *
Are you interested in reserving spa services at The Spa at the Elms during free time on Saturday afternoon? *
Payment Information
Please submit payment ($170 for single occupancy; $145 for double occupancy) to the church office by Sunday, March 31. We are looking forward to our time together!
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