Men’s Retreat Registration Form

CHURCH ASSOCIATION
---Northwest Community ChurchGrace Bible Church

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.
---Yes, I can be a driverYes, please assign me to a carpoolI do not wish to carpool

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

I can leave on Friday any time after ---8 am9 am10 am11 am12 pm1 pm2 pm3 pm4 pm5 pm6 pm7 pmnone of the above

METHOD OF PAYMENT
CashCheckPayPal

*$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:
---NeitherZipline (PLUS $8)Paintball (PLUS $10)

QUESTIONS ABOUT THE RETREAT