Retreat Registration Form

Personal Information Name:* E-mail: Phone number: Permission to take photos?*

Yes No

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By selecting yes you agree to let EDLYA post publically any photos of you taken at the retreat.

Communicant member of an LCC/LCMS congregation?*

Yes No

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Although anyone is welcome to attend our retreats, you should be aware that our synod practices closed communion. If you are not a member of LCC or an affiliated synod, we ask that you refrain from taking communion on Sunday. If you have any concerns about this, please talk to the pastor.

Prove you are human What is the name of this organization? (acronym only all lower case please)*

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Sorry we've been getting a lot of spam recently.

Retreat Information I will be staying:*

All the days! Only some days

Check all that apply:

Friday Saturday Sunday

Meals Needed:*

All Some None

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Meals are provided from Saturday morning onwards. Those who stay for only one meal or those who provide their own food will have a reduced fee of $10.

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This will determine pricing. Our rates are:

Regular: $25
First timer: $20
Married couple: $45 for both together
Bring-your-own-food/Day rate: $10

Carpooling

How will you get there?:

I am driving and have room in my car for others I need a ride I already have a drive Don't know yet

I am coming from:

Emergency Information

Allergies, Severity and Treatment:

Emergency Contact Name:

Emergency Contact Phone Number:

Other Information

Place of Residence:

Current Congregation:

Other comments:

* sections are mandatory