2025 CCCA Illinois Sectional Registration

Your Name (person filling out registrations)*

First NameLast Name
Camp or Ministry Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Sectional Details and Rates:
Tuesday registration 4:00 pm February 25 through
Thursday departure 2:00 pm February 27

Menno Haven Camp & Retreat Center
9301 1575 East St.
Tiskilwa, IL 61368

Rates:
2 nights and 6 meals and all program fees
Single Occupancy Hotel room $175
Double Occupancy $165 per person
Triple Occupancy $155 per person
Dorm Style $150
Day Only $60 each day

HOTEL SPACE IS LIMITED AND WILL BE GRANTED IN ORDER OF REGISTRATION
You will be able to register multiple people on the following pages. Payment can be by mail or presented at the sectional or through PayPal using accounting@dicksonvalley.com.

Please enter the name and email of the first attendee and their housing preference:
Name Registrant #1*

First NameLast Name
Email Registrant #1*
example@example.com
Housing Preferences #1*

Hotel-style housing $175Hotel-style housing (as a double occupant) $165Hotel-style housing (as a triple occupant) $155Dorm-style housing $150Day only (each day with meals) $60
Special Dietary Requests:
#1 Do you have an additional registrant?*

YesNo

SECOND attendee:
Name Registrant #2*

First NameLast Name
Email Registrant #2
example@example.com
Housing Preferences #2*

Hotel-style housing $175Hotel-style housing (as a double occupant) $165Hotel-style housing (as a triple occupant) $155Dorm-style housing $150Day only (each day with meals) $60
Special Dietary Request:
#2 Do you have an additional registrant?*

YesNo

THIRD attendee:
Name Registrant #3*

First NameLast Name
Email Registrant #3*
example@example.com
Housing Preferences #3*

Hotel-style housing $175Hotel-style housing (as a double occupant) $165Hotel-style housing (as a triple occupant) $155Dorm-style housing $150Day only (each day with meals) $60
Special Dietary Request:
#3 Do you have an additional registrant?*

YesNo

FOURTH attendee:
Name Registrant #4*

First NameLast Name
Email Registrant #4*
example@example.com
Housing Preferences #4*

Hotel-style housing $175Hotel-style housing (as a double occupant) $165Hotel-style housing (as a triple occupant) $155Dorm-style housing $145Day only (each day with meals) $60
Special Dietary Request:
#4 Do you have an additional registrant?*

YesNo

FIFTH attendee:
Name Registrant #5*

First NameLast Name
Email Registrant #5*
example@example.com
Housing Preferences #5*

Hotel-style housing $175Hotel-style housing (as a double occupant) $165Hotel-style housing (as a triple occupant) $155Dorm-style housing $150Day only (each day with meals) $60
Special Dietary Request:
#5 Do you have an additional registrant?*

YesNo

SIXTH attendee:
Name Registrant #6*

First NameLast Name
Email Registrant #6*
example@example.com
Housing Preferences #6*

Hotel-style housing $175Hotel-style housing (as a double occupant) $165Hotel-style housing (as a triple occupant) $155Dorm-style housing $150Day only (each day with meals) $60
Special Dietary Request:
#6 Do you have an additional registrant?*

YesNo

SEVENTH attendee:
Name Registrant #7*

First NameLast Name
Email Registrant #7*
example@example.com
Housing Preferences #7*

Hotel-style housing $175Hotel-style housing (as a double occupant) $165Hotel-style housing (as a triple occupant) $155Dorm-style housing $150Day only (each day with meals) $60
Special Dietary Request:
#7 Do you have an additional registrant?*

YesNo

EIGHTH attendee:
Name Registrant #8*

First NameLast Name
Email Registrant #8*
example@example.com
Housing Preferences #8*

Hotel-style housing $165Hotel-style housing (as a double occupant) $165Hotel-style housing (as a triple occupant) $155Dorm-style housing $150Day only (each day with meals) $60
Special Dietary Request: