`October 2nd-4th, 2009 Fall Prayer Retreat Registration`

PLEASE register ALL adults and children who will be attending (submit multiple registration forms if necessary)

Name:
Address:
City:
State:
Zip Code:
Phone:
E-mail:
Full time camper
Part time camper (don't foget to fill in part time info below if you clicked this)

Accommodations:

Age Group (see below for children under 18): 18-29 30-35 36-50 51-65 over 65

Roommate Preference:

________________________________________________________

Children under 18:

Child 1

Name: Age:

Email Address (optional):

Phone Number (optional):

Accommodations:

Roommate Preference:

Child 2

Name: Age:

Email Address (optional):

Phone Number (optional):

Accommodations:

Roommate Preference:

Child 3

Name: Age:

Email Address (optional):

Phone Number (optional):

Accommodations:

Roommate Preference:

Child 4

Name: Age:

Email Address (optional):

Phone Number (optional):

Accommodations:

Roommate Preference:

Child 5

Name: Age:

Email Address (optional):

Phone Number (optional):

Accommodations:

Roommate Preference:

_________________________________________________________

Part Time Campers

Arrival:
Select Approx. Time: AM PM

Departure:
Select Approx. Time: AM PM

Meals Required (part timers- please check the appropriate boxes so we know how many campers will be at each meal):

Friday supper

Saturday breakfast

Saturday lunch

Saturday supper

Sunday breakfast

_________________________________________________________

Please list any special needs:

Please list any special talents:

Are any of the registrants above first time campers? Yes No

If Yes, who? :

Check this box if you would like a copy of this registration form forwarded to the email address you listed at the top of this registration page.