Families
make Memories Click here to see a sample schedule.
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 I October 3-4, 2008
($52/$37)
_____Mother & Daughter Retreat II
October 4-5, 2008 ($52/$37)
_____Father & Son Lakeside
Retreat November 21-22, 2008
($52/$37)
_____Optional Camp Out
Extension November 22-23 Additional cost: ($27/$17)
$ Amount Enclosed:_______________________
$30 deposit per retreat or full payment.Charge to: Mastercard Visa American Express
(3% surcharge when using a corporate account credit card)CC
#____________________________________________________________exp______
Last 3 digits located on back of card_______________________________________
Authorized
Signature:____________________________________________________
Billing address of
cardholder:_____________________________________________
City:___________________________________ST:___________Zip:_______________
Phone of card holder:
__________________________________________________
Deposit is transferable but not refundable.
