Families
make Memories Click here to see a sample schedule.
Please print
registration form (one form per person) and fax to
863.696.1062
If you prefer, you may fax your
registration form and pay
on-line using our secure server.
(Just use the Registration box for fees to be paid - it will appear as a
'donation' but it is a payment)
Mother/Daughter or Father/Son Registration
Adults Name:___________________________________________________Childs Name(s):__________________________________________________
Age(s):_____________________________________________________
Address:________________________________________________________
________________________________________________________
City:__________________________________ St:_______ Zip:_________________
Phone: (include area code)____________________________________________
email address:_____________________________________________________
Home Church/City:__________________________________________________________
_____Mother & Daughter
Retreat October 2-3, 2009
($52/$37)
_____Father & Son Lakeside
Retreat November 20-21, 2009
($52/$37)
_____Optional Camp Out
Extension November 21-22 Additional cost: ($27/$17)
$ Amount Enclosed:_______________________
$45 deposit per retreat or full payment.Charge to: Mastercard Visa American Express Discover
CC
#____________________________________________________________exp______
Authorized Signature:____________________________________________________
Billing address of
cardholder:_____________________________________________
City:___________________________________ST:___________Zip:_______________
Phone of card holder:
__________________________________________________
Deposit is transferable but not refundable.
