ACC Pine Valley Retreat Individual Application

Full Name*

First NameLast Name

Marital Status*

SingleMarried

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Age at the time of retreat*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

I am willing to volunteer in the following ways:

Comments regarding volunteering

Years in the faith

Home Church*

City

Guardian (if under 18)

Lodging Requests (2 individuals)

Day & Time of Arrival*

Names of potential nominees

Rates*

Motel - Full Time - ages 12+Full time with meals, linens included

$300.00 Postmark

Dorm - Full Time - ages 12+Full time with meals

$260.00 Postmark

Family Dorm - Full Time - age 12+ (min. 6 people)Full time with meals

$260.00 Postmark

Dorm - Part Time (1 night) - ages 12+3 meals

$190.00 Postmark

Dorm - Part Time (2 nights) - ages 12+6 meals

$220.00 Postmark

Base CampBase Camp is recommended for men only! Base Camp is located behind the playing field. This camp consists of six large tents on a wooden platform, each capable of holding five bunk beds with a max capacity of ten people per tent. The tents have no heating or electricity, but PVBCC will allow "camping type" heating units and lighting. There is a bathroom facility including sinks, toilet, and shower that has electrical power. There is also a Base Camp Fire Ring that can be used. There is dirt road access to the area with ample parking.

$220.00 Postmark

Ages 8-11 Full TimeFull time with meals

$125.00 Postmark

Ages 4-7 - Full TimeFull time with meals

$100.00 Postmark

Ages 3 and under - Full TimeFull time with meals

$ Free Postmark

Day Registration - Part Time - Child (ages 3 and under)

$ Free Postmark

Day Registration - Part Time - ages 12+No meals

$40.00 Postmark

Day Registration - Part Time - ages 4-11Includes lunch OR dinner

$30.00 Postmark

Day Registration - Part Time - ages 12+Includes lunch OR dinner

$55.00 Postmark

Day Registration - Part Time - ages 4-11Includes lunch AND dinner

$45.00 Postmark

Day Registration - Part Time - ages 12+Includes lunch AND dinner

$75.00 Postmark

Full Registration - Off-site LodgingALL meals

$150.00 Postmark

Linens (per bed)

$30.00 QuantityPostmark

Donationas unto the Lord

$5.00

Amount	Quantity	Price
$5		$5.00
$15		$15.00
$25		$25.00
$50		$50.00
$100		$100.00
$150		$150.00
$200		$200.00

Item subtotal:$0.00

Total

$0.00

Any additional information

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

ACC Pine Valley Retreat Individual Application

Nominees for PV Committee