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2020 Eden Prairie UMC Women's Retreat Registration
*
Indicates required field
Name
*
First
Last
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Room Option: Choose One
*
Option 1 - Private room (shared toilet & shower with neighboring room) $155
Option 2 - Private Suite (private toilet/shower) $195
Payment options: Please choose one.
*
Online payment $155.00
Online payment $100.00
Online payment $55.00
Online payment $195.00
Online payment $95.00
I will pay by check
Retreat Neighbor preference
*
Please list the name of someone you wish to have in the room next to yours or write "none" if it does not matter.
I am interested in a scholarship
*
Yes
No
Optional Contribution for Scholarships
*
I am willing to give $________ for scholarships.
Please list specific dietary needs/allergies/special needs in the box.
*
Emergency Contact Name
*
First
Last
Emergency Contact Phone Number
*
Relationship
*
Transportation
*
Will arrange own transportation
Willing to drive/carpool
Want a ride/carpool
Submit
