2020 Lay Spiritual Retreat

IMPORTANT!!!

You MUST complete all mandatory fields (marked with *) as well as the "SUBMIT" button at the bottom of the form.

You will automatically receive a "THANK YOU" email to confirm that we've received your online registration.

Any additional questions or concerns should be directed to Prijna Gingrich (Registrar) at anp.gingrich@rogers.com or (519) 208-5652.

Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email *

example@example.com

I give permission for my email address to be shared with participants of this retreat. *

Yes No

Congregation *

Room Preference - Please note that rooms are limited and will be assigned on a first-come, first-serve basis. *

Double Single Commuter - No room required

Roommate Preference (if applicable)

Dietary and/or Accessibility Requirements

Payment Options - Please select one. *

I will pay for my registration fee online via PayPal or by Credit Card (below). I will send a cheque (payable to "Eastern Synod") via regular mail to Prijna Gingrich, #412-20 Barrel Yards Blvd. Waterloo Ontario, N2L 0C3. (Please note - your registration is not complete until the Registrar has received your cheque!)

On-Line Payment

All-Inclusive Registration Fee $ 275.00 CAD

Commuter Registration Fee $ 125.00 CAD

Total $ 0.00 CAD

Enter the message as it's shown *