Retreat Form

Retreat Registration

October 20-22, 2023 New Orleans, LA
Full name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Age*
E-mail*
Phone Number*
Emergency contact*

First NameLast Name
Emergency contact phone number*
Do you have any health/ dietary requirements/allergies?*
Local Church and District.*
What is your involvement in local, district, diocese and national ministries?*
I am a young adult and I would like to participate in the Leadership TrainingI am an emerging leader and I would like to participate in the Leadership TrainingI would like to be trained as a Group Leader for Leadership Training
Diocese Parent BodyDiocese United Christian Women’s MinistryDiocese BrotherhoodDiocese SS&HYMDiocese Young Adult MinistryDistrict Parent BodyDistrict United Christian Women’s MinistryDistrict BrotherhoodDistrict SS&HYMDistrict Young Adult MinistryLocal ChurchLocal SS&HYMLocal United Christian Women’s MinistryLocal BrotherhoodLocal Young Adult Ministry
King room (no roommate +$220 added to registration)King room (with roommate)Double queen room (with roommates-up to 4 per room)No room (staying off-site but attending retreat)
Please list roommate(s). If this does not apply, put N/A in box.*
If you have any questions that you wish to discuss prior to participating in the retreat, please contact the coordinator, Erica Brown at 504-275-6094.

We realize plans change and you may not be able to attend after registering. If this occurs, please contact the coordinator immediately.
You will receive a notification with payment information after submission.

Thank you.

We look forward to seeing you in New Orleans!

Bishop Leroy Divinity
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Retreat Registration