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The Great Getaway Registration Form
Thank you for your interest in attending the second retreat sponsored by your HeRememberstheBarren.com blog hosts! Women suffering from barrenness, secondary infertility, or a recent miscarriage are invited to attend. Here are the details:
Retreat date: 6:00 p.m. Friday, August 22nd through 12:00 p.m. Sunday, August 24th
Location: 3519 Sidney St., St. Louis, MO 63104, guest house of Kurt and Karen Rolland.
Cost:$50 for those staying on site, $40 for commuters.
Payment details: Please send your check to Rebecca Mayes, 5600 Cliff Cave Crossing Dr., St. Louis, MO 63129
Maximum attendance: The retreat home can sleep 10. In addition to that number we can also welcome 8 local women who do not need lodging.
Name
First
Last
Mailing Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
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Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
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Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
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Bulgaria
Croatia
Cyprus
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Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
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Luxembourg
Macedonia
Malta
Moldova
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Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Cell Phone
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Email
Church affiliation
LCMS
Other Lutheran
Roman Catholic
Evangelical
Other: please specify below
Food allergies/dietary restrictions
Vegetarian
Dairy-free
Gluten-free
Nut-free
Other: please specify below
What is your favorite drink, dessert, or snack food?
Will you be staying at the retreat house or commuting from home?
Staying on site
Commuting
Mode of transportation if from out of town:
Driving
Flying
Please email any flight details to Rebecca as soon as you know them: rbmayes@gmail.com.
Do you need transportation to and from the airport?
Yes
No
Would you be willing to share a queen-sized bed with another sister in Christ?
Yes
No
Would you like to meet with a pastor during the retreat for private confession and absolution?
Yes
No
Do you need caffeine in the morning?
Yes
No
Please briefly tell us the things you think are important for us to know about you. (i.e. I suffer from infertility, secondary infertility, miscarriages, etc.)
What do you expect out of this retreat? In other words, what do you need?
Is there anything else we should know that would help us make your stay comfortable?
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