Unitarian Universalist Church of Spokane Women's Retreat Registration

Please fill out this form entirely so that we can best suit your needs and requests. The deadline to sign up for the retreat is September 23, 2018.

Name

Address

Phone

This address will receive a confirmation email

First time at the retreat?

Yes No

Did you attend last year?

Yes No

Allergies? Please list:

Special Needs? Please list your needs:

Dietary request (vegan, vegetarian, gluten-free)

Roommate request, if any:

We often find it difficult to find campers that can navigate the top bunk. Would you be able to sleep on top bunk?

yes no

Carpooling encouraged

Can Drive? Need a ride? Unable to carpool

Emergency Contact #1 (please provide 2 contacts with phone numbers)

Emergency Contact #2 (please provide 2 contacts with phone numbers)

The cost of the camp is $130. Please select if you are mailing in a check or paying online in the box below. Please mail checks to: UUCS Women's Retreat, 4340 W. Fort George Write Dr. Spokane WA, 99224 with the words Women's Retreat in the memo line. To pay online please follow the instructions below. The Deadline for the Retreat is September 23, 2018. *Late registration will result in an additional $25 fee. No refunds after September 23, 2018.*

Scholarship

If you would like to apply for a scholarship please contact Deena Romoff, (509) 535-5285, (509) 847-4118, dvromoff@gmail.com. In the box below please post the Scholarship code provided by Deena.

Will you be needing a scholarship? If yes please put the code in the box below.

Yes No

Scholarship Code

Would you like to contribute to the UUCS Women's Retreat Scholarship Fund, any amount will help.

Yes No

Scholarship Amount:

Payment

Total amount paying:

Mailing in your payment?

Yes No

Please click the link below to pay for the retreat. Fill out the section titled Special Events Payment, Women's Retreat.

https://www.eservicepayments.com/cgi-bin/Vanco_ver3.vps?appver3=qJxIIl1t8tGceJYaRNmIKHaactS3QvGIV-MHybq5MSYJ27hyWnbtA3L_qbjkMg6aQGn9IiYAAaoCN8DICb7ZvBwj-r-ebUFX7a8ZRAq0ZwXjkLsRSedBnbLUuPArd0F26lKIaziZl-X-NRY4TrR7QHBI-D-wL2Vc-zChUvWUwSE=&ver=3

Please read the following statement:

There is always a possibility of accident or injury in a camping experience. I will not hold the Unitarian Universalist Church of Spokane or its staff or leadership responsible for illness or injury sustained on this campout.

By clicking submit you are agreeing to the statement above.

Unitarian Universalist Church of Spokane Women's Retreat Registration

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