Pa Women of Worth Retreat Registration Form

Un-Plugged Retreat

Free at Last Ministries
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Home Church*
I am currently: Check the one that best describes you*

Majorly Burning OutMildly Burning OutLooking for Clarity in my purposeNeeding a Reset or RestartOther
What I cannot do while I am here:
1. Work, worry, have a bad attitude
2. Use my Computer, tablet, cell phone, iwatch
3. Take any kind of narcotic (even if prescribed)
4. Promote yourself through social media platforms.
What I will need:
1. A Bible/notebook/pen
2. Necessary hygeine, vitamins, etc...
3. Patience, joy, peace, and love
4. Openness to revelation and clarity
5. Respect of all time schedules
Rooms are Dorm Style:

All rooms sleep two and bathroom is set up with 5 showers, and 5 sinks. You will be assigned a bed, shower, and sink to share with your roommate.

Linens, towels, and bedding will be provided. You can bring your own pillow, towels, etc...

Clocks are available in rooms and throughout the campus. You are encouraged to un=plug from all devices.

We reserve the right to fill each room with your assigned roommate and this may not be someone you know.

Please keep rooms and bathrooms clean. Clean up after yourself

Meals

All meals will be provided and part of your weekend schedule. If you have dietary restrictions please let us know while you are registering. There will also be snacks, fruits, yogurts available in between meals times.

Drinks

Drinks will be provided. We will provided different drink options at meal times. Coffee and tea will be provided throughout your days. We will not provide energy type drinks and encourage you to unplug from these during your stay.
Date of weekend retreat you are registering for?*
Do you have any sleep patterns that could be distraction to someone sharing a room with you?
Do you have any food allergies that would require a special diet or precautions?
What kind of medications do you have to take during the retreat?
What is your biggest spiritual need at this time?
What do you hope to gain from this weekend?
Registration Options
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Dorm Room Registration (1 person)$150.00
Deposit to confirm your registration

Registering for:

Total $0.00
Registration Coordinator:

Pastor David Norris MATS

Founder/President

812-583-8115 (Leave Message)

Retreat Coordinator:

Pastor David Norris MATS

812-583-8115 (Leave Message)

Website: www.freeatlast777.com

Email: support@freeatlast777.com

Facebook: www.facebook.com/healing at free at last ministries
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Un-Plugged Retreat