2021 Men’s Retreat Registration 2021 Men’s Retreat Registration DWR registration OK Question Title * 1. Registration costs for event: Before 9/1 $30 9/2-10/14$40 OK Question Title * 2. Contact Information Name Home Church Attendee Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number OK Question Title * 3. Will you need van shuttle assistance while at retreat? Yes No OK Question Title * 4. I will be attending: Friday only Saturday only Sunday only Friday and Saturday only The entire event for all three days OK Question Title * 5. Any food allergies? OK Question Title * 6. I am reserving a: Private Room Double Room with a roommate Double Room with 2 roommates Double Room with 3 roommates OK Question Title * 7. Please list roommates if applicable: OK Question Title * 8. Do you need a handicap room? Yes No OK Question Title * 9. I would like to Dorm in: Holt Private Room ($100/night) Holt Hotel with 1 Roommate ($50/night) Holt Hotel- I am 3rd person in room ($33.34/night) Holt Hotel- I am 4th person in room. ($25/night) OK Question Title * 10. I will be eating the following meals: Friday dinner $10.00 Saturday breakfast $6.50 Saturday Lunch $8.00 Saturday dinner $10.00 Sunday Breakfast $6.50 Sunday lunch $8.00 OK Question Title * 11. I plan to pay At the event Please invoice me to pay by credit card when you receive my registration I will send a check to the Regional office at 1402 Washington Ave Parkersburg WV 26101 I will email the regional office at jrheaallen@yahoo.com to make arrangements OK DONE