RETREATS: $105 total payment per person enclosed $50 deposit per person enclosed

Ladies: 1 -March 16-18 FULL 2 - April 20-22   3 -April 27-29   4 -September 21-23 FULL 5 -October 12-14 FULL 6 -November 2-4

Men: 1 -March 23-25   2 -October 26-28    Couples: 1 - May 25-27 2 -Aug 31- Sept 2 Singles: May 18-20

CONFERENCES Total Payment enclosed Adults: $165 ea. Children: 7-18 $150 ea. Children: 2-6 $80 ea. Children under 2: Free Deposit enclosed ($50 per adult, $25 per child over 2 years) .

Family Relations: July 2-7   Family Bible: August 6-11

Name _________________________________________________________________________________________
________ Male   _________ Female       Age _________   Date of Birth ____/_____/_____ 
Address _______________________________________________________________________________________
City _______________________________________________ State ______________Zip+____________+_______
Home Phone  ( ________ )_________-________   Work Phone ( ________ )_________-__________ 
Church Name__________________________________________________________________________________
Address _______________________________________________________________________________________
City _______________________________________________ State ______________Zip+____________+_______
Group Leader (if applicable) _____________________________________Phone  ( ________ )_________-________ 
Pastor _________________________________________________________________________________________

 Roommates: I would like the following people to be my roommates:
______________________________________________________________
______________________________________________________________

Specific Housing Request - Full payment and completed registration form required. Advance fees are not refundable.
1st choice ___________________________
2nd choice ___________________________

I understand that pictures will be taken during our time at Cedine. I give my permission for the use of such pictures for the promotion of Cedine's camp, retreat or conference ministry.

Signature _________________________ Date of Birth ____/_____/_____ 

 

Family Conferences only: Children attending with you: (name and DOB) Child's name _________________________ Date of Birth ____/_____/_____  Child's name _________________________ Date of Birth ____/_____/_____  Child's name _________________________ Date of Birth ____/_____/_____  Child's name _________________________ Date of Birth ____/_____/_____  Please list additional children on separate piece of paper.

Couples Retreat and Family Conferences Only: Please list spouse's name and date of birth as well as your wedding anniversary. Spouse ______________________________________________________ Date of Birth____/_____/_____ Wedding Anniversary____/_____/_____