Clone of Room Reservation Request

Full Name*

First NameLast Name

Preferred Name for Name Tag:*

E-mail*

example@example.com

Phone Number*

If this is a cell number, may we text event information to you?*

YesNo

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Any Dietary Restrictions/Allergies?*

(Please list all; indicate "N/A" if none)

Any Special Needs?*

(Please list all; indicate "N/A" if none)

Carpooling

I will need a ride to the RetreatI am able to drive others to/from the Retreat (please add the number of women you're able to drive on "other" line below)Other

Name*

First NameLast Name

Relationship To You*

Phone Number*

Please enter a valid phone number.

Emergency Contact*

please provide full name, relationship to you, and phone number:

For Wednesday, March 4th (choose one):*

Private room @$225.00Double Room @$175.00 per person (If choosing your own roommate, include her name using "Other" line below; both must choose each other)Please check here if low-rise, step-in shower is required per Special Needs section aboveOther

BONUS: Choose now to stay an additional night with new and old friends! Special room pricing for Thursday, March 5th ONLY (based on same retreat room type chosen above). Please check one:*

Private Room @$150.00 for second nightDouble Room @$75.00 for second nightI will not stay an additional night

Total Cost

In U.S. Dollars

➡️When you click the "Submit" button, your registration information will be saved AND an online credit card payment option will appear. If you are not ready to make your payment, just close that page. Whenever you are ready, you can simply go to the "Giving" tab on the church website and choose Womens Retreat to submit your payment. Please note your registration will be considered complete on the date payment is received.

Note that those who register AND pay in full by December 15, 2025, will receive a special thank you gift upon check in at the event! Final payment is due on or before February 1, 2026. Please note refunds will be granted only in the case of a true medical emergency.

Women's Retreat Registration Form

Emergency Contact

HOW TO PAY