Riverside Women's Retreat

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Friday, September 13th through Sunday, September 15th, 2013
Camp Tecumseh Leadership Center

Name *

Phone Number

E-mail Address

When will you be in attendance? *

Check all that apply. Deduct $50 Early Bird Discount if registering for the FULL WEEKEND and paying before July 31.

The whole weekend (3 days, 2 nights) $131

Part of the weekend (2 days, 1 night) $90

Day Sessions Only - Friday $20

Day Sessions Only - Saturday $54

Day Sessions Only - Sunday $40

Required

Childcare

I am a nursing mother and am interested in the on-site nursery $20

Scholarship

I would like someone to contact me about receiving a scholarship

I would like to help provide a scholarship

Other:

Payment *

choose all that apply

I have already paid

I still need to pay

I would like to be on a payment plan

Other:

Required

Transportation

I will drive myself

I am interested in carpooling

I am willing to drive a carpool

Other:

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