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Ladies Retreat 2019

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Who Are You?

First Name *

Last Name *

Address *

City *

Province *

Postal Code *

Country

Phone *

Email *

Home Church

Registration Fee

Retreat Registration

Full Payment ($145+GST) - $ 152.25

Deposit Only - $ 50.00

- none -

Total Fee(s)

Credit Card Information

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Health Information

Do you have any health-related dietary needs? (Please be specific.)

Any Allergies? Please Explain.

Provincial Health Care Number

Accomodations

Lodge or Cabin *

Lodge Cabin

Requested Roommates

Acknowledgement of Risk

View the Acknowledgement of Risk form

Acknowledgement of Risk

Yes, I agree to Camp Evergreen's Acknowledgement of Risk form

**Please print off the Acknowledgement of Risk Form, sign it, and bring it with when you arrive to camp.