First Name :

Last Name:

Date of Birth mm/dd/yyyy:

Address:

City:

State/Province:

Postal Code:

Country:

Your Email Address:

Please enter your telephone numbers, including area code, below.

Home Telephone:

Work Telephone:

Cell Telephone (if you don't have a cell phone please provide the best number to reach you in the cell phone field):

Your Gender: Female Male

Have you previously attended a retreat, camp or other event with Cedine Ministries? Yes No

Housing Choice

Full payment and completed registration form is required to reserve a specific housing unit. You must complete this registration form along with full payment for each person requesting the unit. Please note housing is assigned as full payment is received. Some units will be reserved as much as a year in advance. We reserve the right to reassign rooms to those who have mobility needs, even if you have paid in full for that room. NOTE: This is only if absolutely necessary. We make every attempt to house you as requested when you pay in full.

Comments or Requests:

Roommates

If possible I would like the following people to be my roommates.

#1:

#2:

#3:

#4:

Church Information

Church Name:

City:

State/Province:

Pastor's Name:

Group Leader:

If you are on staff with the above church, please provide your Church Staff Position:

Guest Agreement

I agree to abide by all the retreat policies. Open/download our Retreat Policies document.

Refund and Transfer Policy

I agree that the submission of this online form, along with my payment, indicates that I understand the refund and transfer policy. Transfers to another retreat MUST be made at least 14 days before the registered retreat begins. The payments are transferable to another retreat this year or next year depending on availability as long as you have given a 14 day notice. You may transfer payments to an unregistered person if you are unable to attend. No payments may be transferred to a person who is already registered. If you are unable to attend, cannot transfer it to an unregistered person, and have not notified us at least two weeks prior to the retreat, your money is not refundable or transferable.

I have read and understand the refund and transfer policy.

Upon clicking the Register button you'll be provided with a confirmation of your registration. Please print a copy before proceeding to the final step of submitting your registraion fees online!