2013 Women’s Ministries Retreat Eastern Division Western Division September 12-14 September 19-21

Church ______________________________________________ Church City ________________________

Church Phone ________________ Section________________

**PLEASE FILL OUT THE CONTACT INFORMATION SO WE MAY CONFIRM YOUR REGISTRATION**

Contact Person _______________________________________ Daytime Phone (____)__________________

Home Address ___________________________________ City, State, Zip ______________________________

E-mail Address _______________________________________________________Confirmation will be emailed

Hotel

Bedding & Towels WILL be provided

4 or 5 per room

Cost $120.00 (per person)

After August 1st Add $10.00

Motel (On the Hill)

Bedding & Towels WILL be provided

Upper room (2 beds) 4 per room $100.00 per person

Upper room (2 beds) 3 per room $110.00 per person

Upper room (2 beds) 2 per room $120.00 per person

Lower room (1 bed) 2 per room $100.00 per person

Lower room (1 bed) 1 per room $110.00 per person

After August 1st Add $10.00Dorm

Bedding & Towels will NOT be provided(The beds are twin size)

Cost: $100.00 per person

After August 1st Add $10.00

$25 non-refunded up to Aug 1st. After that date there are NO refunds. Sorry no exceptions

(All monies are transferable within your own group)

Hotel - # of Ladies _______ [ ]4 per room [ ]5per room Amt Paid $__________

Motel - # of Ladies _______ [ ]4 upper [ ]3 upper [ ]2 upper

[ ]2 lower [ ]1 lower Amt Paid $__________

Dorm - # of Ladies _______ [ ] Bld 1 [ ] Bld 2 [ ] Bld 3 Amt Paid $______________

Registration Only - # of Ladies __________ Amt Paid $__________

After August 1st _______ X $10 Amt Paid $__________

Craft Tables _____table/s X $10 Amt Paid $__________

TOTAL NUMBER OF LADIES REGISTERED ON THIS FORM_________ TOTAL PD $__________

Check Retreat Attending

Registration Only $30Meals & Lodging Not included

Register in Advance

Before August 1st ONLY $25

Ladies Attending

List first and last names of ladies and how you want them housed

HOTEL1.__________________

2.__________________

3__________________

4.__________________

5. _________________

1.__________________

2.__________________

3__________________

4.__________________

5. _________________

1.__________________

2.__________________

3__________________

4.__________________

5. _________________

1.__________________

2.__________________

3__________________

4.__________________

5. _________________

MOTEL

1.__________________2.__________________3__________________4.__________________

1.__________________2.__________________3.__________________4.__________________

1.__________________2.__________________3.__________________4.__________________

1.__________________2.__________________3.__________________4.__________________

1.__________________2.__________________3.__________________4.__________________

1.__________________2.__________________3.__________________4.__________________

1.__________________2.__________________3.__________________4.__________________

DORM

1.__________________2.__________________3__________________4.__________________5.__________________6.__________________7.__________________8.__________________9.__________________10._________________11._________________12._________________13._________________14._________________16._________________17._________________18._________________19._________________20._________________21._________________22._________________23._________________24._________________25._________________26._________________27._________________28._________________29._________________30._________________31._________________32._________________

Return forms to: To pay by CC please call 417-

881-1316 Women’s Ministries Dept

528 W Battlefield

Springfield, MO 65807

*You may also use separate sheet to indicate housing