Your Name (required)
Your Street Address (required)
Your City (required)
Your State (required)
Your Church, Church City & State (required)
Your Phone (required)
Your Email (required)
Emergency Contact Name (required)
Emergency Contact Phone (required)
How much of the retreat will you be attending?
Whole RetreatFirst Night OnlySecond Night OnlyOther
Do you need a scholarship for the registration fee?
NoYesI can help scholarship others
Host FamilyHotel (on your own)
Additional information for the retreat team. Include any dietary restrictions. (optional)
© 2019 The Diocese of Quincy, Anglican Church in North America All Rights Reserved.
Design by ANKOR