Retreat Registration - Hope and Renewal Marriage Ministry

  • Hope and Renewal Marriage Ministry

    2026 Marriage Retreat  –  Registration Form
  • Date*
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  • Format: (000) 000-0000.
  • Ok to text?
  • Format: (000) 000-0000.
  • Ok to text?

  • Emergency Contact

  • Format: (000) 000-0000.
  • Do you have any dietary restrictions or health concerns?

  • Marriage Information

  • Which statement best describes the current state of your marriage? Each spouse should check only one. (This information is confidential and will only be shared with retreat leaders.)
  • Do you qualify for the Illinois Free Will Baptist Scholarship*?

  • *The Christian Education Board of the Illinois State Association of Free Will Baptists provides $100 scholarships toparticipants from Free Will Baptist churches in Illinois. This reduces the total cost to $150.

  • Payment Information

  • Please indicate the amount of payment that will be submitted with this application (The entire balance must be paid by the start of the retreat April 10, 2026. No refunds after April 1.):*

  • The entire balance must be paid by the start of the retreat, April 10, 2026. No refunds will be issued after April 1, 2026. Registration fees may be transferred to other participants.

  • Confidentiality Agreement

  • For the privacy of all participants and staff, we ask you to keep everything shared during the retreat confidential. 

  • Do you agree to respect this commitment:

  • Please return application with payment (if paying by check) to:

    JCity Center for Hope and Renewal

    504 E. Broadway Blvd.

    Johnston City, IL 62951

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    For more information email jcitycenter@gmail.com or call 618-952-1272

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