Leaving Home Retreat Registration Form for Individuals
Please write in the date of the retreat you are registering for here.
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Name
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First Name
Last Name
Preferred Pronouns
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Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name and Phone Number
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Affiliation:
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Do you require any of the following:
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Assistive listening device
Seat near the front
Wheelchair access
Wheelchair access to working tables in the room
Scent-free room
None
Other: Please explain.
If you have any dietary restrictions, please list here. Otherwise, write "none."
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I understand that I will meet with my retreat facilitators and retreat attendees on Zoom approximately a week after returning home to discuss actions to take in response to what I have learned at the retreat.
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I understand
I do not understand
I understand that a minimum of 10 people are needed for the retreat to run. I will be contacted as soon as that minimum is reached so that I can make my travel arrangements.
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I understand
I do not understand
I understand that all registrations are to be paid by check. I will make out my check to "Church of the Apostles." In the memo section I will write "Leaving Home Retreat" and the date of the retreat I am registering for. I will mail the check to: Church of the Apostles, Attn: Leaving Home Retreat, PO Box 68435, Oro Valley, AZ 85737-8435.
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I understand
I do not understand
Submit
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