Nakonha:ka Retreat
October 3-5, 2025
Participants Information
Last Name
*
First Name
*
Middle Name
Preferred Pronouns
*
He/Him
She/Her
They/Them
Other
Preferred Language for table group discussions
*
French
English
Bilingual
Type of Ministry
*
Active Order of Ministry
Retired Order of Ministry
DLM
LLWL
Lay Leader
Staff
Other
Address
*
City
*
Province
*
Postal Code
*
Birthdate (Yr Only)
*
Telephone #
*
-
Area Code
Phone Number
Cell Phone
-
Area Code
Phone Number
Emergency Contact Info
Emergency Contact Name
*
Emergency Number
*
-
Area Code
Phone Number
Emergency Number #2
-
Area Code
Phone Number
Email Confirmation
Email confirmation will be sent by email
Other Information
How did you hear about our Retreat
Please Select
Letter
Phone Call
Regional Newsletter
Promotional Event
Other
First time attending a retreat
*
Please Select
Yes
No
Other
Do you require a receipt
*
Please Select
Yes
No
Other
Transportation
I need transportation from/date and time
I have my own car and can offer car pool from/date and time
I will arrange my own transportation
Health Information
List any accessibility or health requirements you have
List any allergies (ex: bees,peanuts, dairy)
List any Medications in case of emergency
Any dietary needs that we should know about?
Photo Release
I agree that photos taken at the retreat can be used for any purpose
Yes
No
Arrival Date
-
Month
-
Day
Year
Date
Departure Date
-
Month
-
Day
Year
Date
Registration Cost
Early Bird before August 15 is $175.00 and payment must be received before that date (includes one night lodging and 4 meals) After Aug 15 $200.00 If you are extending your stay please contact Valerie Nickson 514-268-0228 for details of extra cost. Last day for registration is August 29,2025 and no refunds will be issued after this date as the rooms will be reserved and payment will be made to the Manoir. Please send your payment as soon as you register
Method of payment
Cheque
etransfer
Be certain to enter your email address
correctly on the registration form to receive confirmation via email with in 2 weeks. Please note that registration is only confirmed after payment has been received.
Cheques should be mailed to:
Nakonha:ka Regional Council, United Church of Canada
225 50th Avenue, Lachine, QC H8T 2T7 Attn B, Ruse
Etransfer payments should be sent to the following address
bruse@united-church.ca
Submit
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