Young Adult DP Retreat Registration Form

Participant Info

Name*

Email*

Phone Number*

Gender*

Male
Female

Date of Birth*

Current City*

State*

How did you hear about this workshop?*

Are you physically able to go hiking?*

Do you have any specific dietary needs?

Vegetarian
Lactose intolerant
Vegan
Gluten free
Allergies
Other

Promotional Code

Retreat Info

Month/Year*

Fee*

Suggested Amounts

4 Person Room (Shared Queen Beds) ($400)
2 Person Room (ie. a Couple) ($500)
Commuting Locally ($285)

Do you need a private room? (Cost is $200 extra)*

Please indicate your roommate preferences, if applicable.

Total

$0.00

Tell Us A Bit About Yourself

What are you up to in your life right now?*

What are you most looking forward to about this retreat?*

What questions do you have or areas would you like to explore about life and faith?*

Billing Information

Name*

Credit Card*

Visa
Mastercard
American Express
Discover

Address*

Email*

Confirm Email*

Phone Number*

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