2018 Women's Retreat Registration

WOMEN IN MINISTRY GETAWAY

August 17-18, 2018 | Roanoke Campground
$25 per person, includes meals and retreat activities. Rooms in the new dorm will be available free of charge. Attendees can also secure their own lodging at a local hotel. Visit our website for a list.

* American Express, Mastercard, and Visa Only *
Name *

First Name Last Name

Address *

Mailing Address
Street Address Line 2
City	State
Zip Code	Country

Primary Phone: *

- Area Code Phone Number
Email: *
Local Church *
If your church is not listed, please choose "other" and provide the church name below.
Other Church Name
Your Ministry Role
Would you like to reserve space in a dorm room (available free of charge)?

Yes No
If yes, do you have a roommate request?

Payment Information *

Getaway Registration $ 25.00

Total $ 0.00

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

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