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Unity Women's Ministry Event
Online Registration Form

Registration deadline is October 3, 2010. Due to Retreat Center confirmation guarantee, no registrations accepted after this date. No refunds after this date.  Registration fee covers materials, lodging, meals and snacks. Further information regarding what to bring will be sent following registration. GENERAL INFORMATION and QUESTIONS: Rita Manning, RitaManning115@msn.com or 480-396-9565.

First Name
Middle Name
Last Name		 *

*
Preferred Name on your Nametag
 *
Address 1 *
Address 2
City *
State & Zip Code *
Email #1 *
Email #2
Home Phone *
Cell Phone

SELECT your registration option
and amount *


 Registration Payment - REQUIRED*

Select TYPE of payment - REQUIRED
and
DATE of payment *

 Type of Payment - REQUIRED* Include payment date below...




with Unity of Divine Love Spiritual Center


Date of Payment - PLEASE SELECT DATE


We need the date of payment so we can match your online form submission with your received payment. Thanks.
Name of Roommate?
If you know the name of your roommate, please enter it in the box.
Special Needs:
Handicapped Accessible Room?
Do you need a Handicapped Accessible or special help with moving around the Room or special help with moving around the retreat grounds?

If yes, please explain if necessary.
Special Needs:
Lower Bunk Only
Do you need a LOWER Bunk?


If yes, please explain if necessary.
Special Needs:
Vegetarian Meals
 Do you desire VEGETARIAN Meals?

Special Needs:
Carpooling Assistance
Do you need Carpooling Assistance?


If yes, please explain if necessary.

Unity Women's Ministry
Event Agreement

AGREEMENT - The Unity Women’s Ministry holds the highest good for everyone, however the ministry and its volunteers cannot be held responsible for damages or injuries incurred as a result of your participation in this or any UWM event. I acknowledge, understand and release all liability with my "virtual" signature by checking the box.
Additional
Comments
and
Questions