Blind & Visually Impaired Retreat (Nov. 6-8, 2026)

Name

First NameLast Name

Gender

Email

Phone Number

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState

Zip Code

SF JSON

Church Name

Food Allergies or Dietary Restrictions

Would you like an orientation tour of the building on Friday afternoon?

Which best describes you?

What type of program would you prefer?

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Format: (000) 000-0000.

Emergency Contact's Relationship to You

Accommodations

Double Room

This comes with 6 meals. You may provide roommate information below. If no roommate information is provided, you will be assigned a roommate. Please note that your roommate must complete a registration form as well.

$140.00

Single Private Room

This comes with 6 meals.

$180.00

Enter coupon

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Will you have a helper/guide who will room with you or a preferred roommate?

Helper/Guide/Roommate Name

First NameLast Name

Helper/Guide/Roommate's Relationship to You

Blind & Visually Impaired Retreat

Accommodations*

Accommodations