ND Catechesis Retreat Registration Form

ND Catechesis Retreat Registration Form
2026

Hosted at St. Paul’s Lutheran Church
April 10-11, 2026

Lost in the Scroll? Living Sober-Minded in a Digital World
Plenary Speakers:
Pastor Parkhurst from Cavalier Church
Pastor Durham from UND Wittenburg Chapel
Liturgist:
Pastor Walla

Registrant Section
Registrant Full Name*

First NameMiddle NameLast Name
Gender

MaleFemale
Birth Date

DayMonthYear
Birth Date

MonthDayYear
Mobile Number*

Area CodePhone Number
E-mail*
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Conference related question

I have a disability/medical conditions/dietary or special needs: If checked please detail in provided comment box.
If you checked disability/medical conditions/dietary or special needs please put specifics:

Indicate which age group the Registrant will be in at the time of conference.

	Youth (11-17)	Young Adult (18-20)	Adult (21+)	Pastor
Group

Parent/Guardian Section
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email
example@example.com
Address if different then Registrant

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I grant permission for my minor child, named above as Registrant, to attend the ND Catechesis Retreat. I assume all responsibility and liability for injury to said minor while at the Retreat. I also give the Retreat permission to use any still, audio, and/or video images in publicity and news releases. *

Clear
Date*

Payment
Retreat fee is $50 per person.
Payment Option

Mailing Check to St. Paul's Lutheran Church 200 Burdick Expy E Minot ND 58701Group Leader/Chaperone will bring check to RetreatPay via CC and will cover the service charge: https://secure.myvanco.com/YHTN/home Choose "other" option

ND Catechesis Retreat Registration Form2026