Candidate Form

Attend a Weekend Form
ROGTD Weekend*
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Birth Date*

MonthDayYear
Cell Phone*

Area CodePhone Number
E-mail*
This is where you will receive your confirmation
Married*

YesNo
Church You Attend
Have You Previously Attended a Tres Dias/ACTS/WTE/Cursillo Retreat?*
Are You a Veteran?
Branch of Military Service
Are you a smoker?*

YesNo
How Are You Paying the $226 Fee?*
Note: You will have an option to pay online after submitting this form.
What is your t-shirt size?*
What is your ring size?
Emergency Contact Name*
Emergency Contact Number*
Emergency Contact Relationship*
Any Special Needs You May Have? Food Allergies, Physical Limitations etc?*
I understand that although there will be an emergency phone available on the weekend, I am not allowed to have my personal cell phone or wristwatch on the weekend.*

Yes
I understand that due to contractual obligations between River of Grace Tres Dias (ROGTD) and Bridgeport Camp and Conference Center, ROGTD cannot refund any fees after Thursday, October 9th, 2025 for the Men's weekend and October 16th, 2025 for the Women's weekend.

Yes
Sponsor Information
Name*
Phone Number*
Sponsor Email Address*
Internal Audit Information

DO NOT FILL OUT THIS SECTION
*ATTENTION - CANDIDATE AND SPONSORS*

DO NOT FILL OUT THIS SECTION. THIS IS FOR OUR ROGTD BOARD MEMBERS ONLY
Payment
Check or PayPal Number
Date Paid

MonthDayYear
Date
Internal Note
Editable by admin only
Should be Empty:

Attend a Weekend Form

Sponsor Information

Internal Audit Information