Registration form for someone attending as part of a group of 10 or more people from the same organization
Please type in the date of your retreat
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Name
*
First Name
Last Name
Preferred Pronouns
*
Email
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name & Phone Number
*
Back
Next
Do you require any of the following?
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Assistive Listening Device
Seat near front
Wheelchair access
Wheelchair access to working tables in the room
Scent-free room
None
Other: Please explain
If you have any dietary restriction, please list here. Otherwise write "none."
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I understand that I will meet with my retreat facilitators and the other participants on Zoom approximately a week after returning home to discuss actions to take in response to what I learned at the retreat.
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I understand
I do not understand
Affiliation
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Please write the name of your group's organizer here:
*
I understand that all registration is to be paid by check. Checks will be made out to "Church of the Apostles". In the memo of the check, the date of the retreat and "Leaving Home Retreat" will be indicated. Checks will be mailed to: Church of the Apostles, Attn. Leaving Home Retreat, PO Box 68435, Oro Valley, AZ 85737-8435.
*
I am sending my own check
The group's organizer is sending one check for the entire group
Other
If you are the group's organizer, please write in the names of everyone in your group here:
Submit
Should be Empty: