SCA Winter 2023 Retreat Registration

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Name* This field is required.
First Name
Last Name
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E-mail* This field is required.
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Phone Number* This field is required.
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Is This Your First Retreat?* This field is required.
YesNo
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Number of Previous Retreats:
How many?
How many?
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30+
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Transportation:* This field is required.
I am taking the train with the group.
I am driving.
Other
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I am driving and can take the following number of additional passengers:
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Have you received the COVID-19 vaccination?* This field is required.All attendees are required to have the double shots from Pfizer or Moderna, or the single shot from J&J. The booster is STRONGLY encouraged.
YESNO
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Upload COVID-19 Vaccination
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Terms and Conditions* This field is required.All attendees are required to have the double shots from Pfizer or Moderna, or the single shot from J&J. The booster is STRONGLY encouraged.
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I am willing to do service for my fellows by planning and leading a workshop. My preferences in order are:
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Payment* This field is required.
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My Bag
0
My Bag
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$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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ORDER SUMMARY
Total costUSD
Winter 2023 Retreat Full Payment$235 + Online Transaction Fee
$241.00Edit
Back
Scholarship RequestUp to $100 Scholarship + Online Transaction Fee
$FreeEdit
Back
$138.27 ($100 Scholarship)
$138.27 ($100 Scholarship)
$163.83 ($75 Scholarship)
$189.37 ($50 Scholarship)
$214.92 ($25 Scholarship)
Scholarship Amount Request
I'll add $15 for the Scholarship Fund$15 + Online Transaction Fee
$15.65Edit
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Total cost $0.00
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URGENT!

You selected to contribute $15 to the scholarship fund, but you did not select a Full Payment Registration ($241) or Partial Scholarship Payment Registration.

Please click "PREVIOUS" and return to the previous page. From there, select one of the registration payment options.

You will not be able to submit this registration form until this is corrected.
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Any Additional Message for Retreat Committee?Payment follows this page when you click "SUBMIT".
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