2025 Empowerment Retreat Registration Form

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Theme: FOR SUCH A TIME AS THIS (Esther 4:14)Venue: Lake Lake Bennett Resort Date: 12th-14th December 2025
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Name* This field is required.
First Name
Last Name
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E-mail* This field is required.
example@example.com
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Mobile Number* This field is required.
The number provided may be used to contact you
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Will you require accommodation at the camp during the event?* This field is required.
Yes
No
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Attending
Total number people attending
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Enter details of those staying in camp, including the person registering* This field is required.
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Dietary restrictions* This field is required.
None
Gluten Free
Lactose free
Vegetarian
Vegan
Kosher
Other
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Other (please specify)If you have any dietary needs not listed above, please let us know here so we can do our best to accommodate them.
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Allergy? Please check all that apply* This field is required.If your option isn’t listed, tick "Other"
None
Food
Medical
Environmental
Other
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Other (please specify)Let us know, so we can include it and make sure nothing is missed.
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Want to invite family/friends?* This field is required.
Yes
No
Maybe
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Please give details of 2 people whom you feel will benefit from the retreat. * This field is required.
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Please give details of the person whom you feel will benefit from the retreat.
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Personal Information collection notice* This field is required.
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Camp accomodation
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My Bag
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My Bag
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ORDER SUMMARY
Total costAUD
Adult Rate applies per night for camp accommodation.
$25.00AUDEdit
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Number of Adults
1 night
1 night
2 nights
How many nights?
Subtotal: $0.00AUD
Youth Youth (ages 16–18). Rate applies per night for camp accommodation.
$12.50AUDEdit
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Number of youth
1 night
1 night
2 nights
How many nights?
Subtotal: $0.00AUD
Total cost $0.00AUD
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Invoice ID
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Payment Methods
Debit Or Credit Card
Select PayPal Method
Choose from one of the PayPal options to make your payment.
Buy with
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