Men’s Retreat Registration Form

Date:  November 18 -19
Where:  Payson, AZ
Speaker:  Jerry Wragg
Cost:  $90

 

CHURCH ASSOCIATION

FIRST NAME

LAST NAME

ADDRESS

CITY

STATE

ZIP CODE

EMAIL

HOME PHONE

CELL PHONE

EMERGENCY CONTACT NAME

EMERGENCY CONTACT PHONE NUMBER

MEDICAL CONDITION WE SHOULD BE AWARE OF

CARPOOLING OPTION
Carpooling is highly encouraged as there are limited parking spaces.

If you can drive, how many seats (including driver) does your car have?

I can leave on Friday any time after

METHOD OF PAYMENT

*$25.00 of registration fee is non-refundable and registration is guaranteed upon receipt of payment.

FREE TIME ACTIVITIES
During your free time on Saturday, ziplining and paintballing are two options for you at an additional cost (please include with your payment). Since both events happen at the same time, you can only chose one when paying below. Other free time activities for no additional cost include basketball, soccer, volleyball, and frisbee golf.

Please Register Me for the Following Activity:

QUESTIONS ABOUT THE RETREAT

 

Did you register and select the PayPal option?  Select and click below!

Accommodation Choice
 
 
Want to help other men become “Men of God”?  You can make a donation of any amount to help pay part of the cost for someone that cannot afford to pay for this retreat.  Simply drop off your donation at the church or drop it in the mail, or if you would like to charge a donation, simply click the “Donate” button below and use PayPal to process your credit/debit card.