EmailMe Form - Ladies' Retreat Registration Form

Today's date

MM / DD / YYYY

Your birthday

MM / DD / YYYY

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Home phone

### - ### - ####

Cell phone

### - ### - ####

Any physical limitations? (for housing purposes)

yes

no

If yes, Explain

Dietary restrictions or allergies?

yes

no

If yes, explain

1. Roommate request

Roommate requests (no single-occupancy rooms are available)
3-4 people will be assigned to a room.)
Please note: your requested roommate(s) must request you!

2. Roommate request

3. Roommate request

Are you willing to share a full/queen bed?

yes

no

Are you willing to sleep in a top bunk?

yes

no

Are you willing to be assigned to Bear Lodge?

yes

no

If single, are you willing to share a room with someone you don’t know?

yes

No

Please list any workshops (crafts, classes, activities, etc) you'd be interested in participating in at this Retreat

Would you like to lead a workshop or session? If so, please list which ones:

yes

no