2012 Women’s Ministries Retreat

1. 2012 Women’s Ministries Retreat Eastern DivisionWestern Division September 13-15 September 20-22 Check Retreat Attending 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 $110.00 (per person) After August 1st Add Late Fee $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 Late Fee $10.00 Dorm Bedding & Towels will NOT be provided (The beds are twin size) Cost: $95.00 per person After August 1st Add Late Fee $10.00 Registration Only$30 Includes All Services & All Workshops ~No Meals or Lodging ~ Walk – On Cost will be $35 $25 non-refunded up to July 31. 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 $__________ Late Fee’s (after July 31) _______ X $10 Amt Paid $__________ Craft Tables _____table/s X $5 Amt Paid $__________ TOTAL NUMBER OF LADIES REGISTERED ON THIS FORM_________ TOTAL PD $__________

2. Ladies Attending List first and last names of ladies and how you want them housed HOTEL 1.__________________ 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 sheetto indicate housing