WV Women’s Retreat Registration Question Title * 1. Registration costs for event: Before 7/1 $25 7/2-8/1 $30 8/2-9/6 $35 OK Question Title * 2. Contact Information Name Home Church 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 Dorm style room with several 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:(Currently Holt Hotel is sold out. If you choose Holt, you will be placed on a waiting list for Holt but will be placed in Main unless a room opens up in Holt.) Main Private Hotel Style ($75/night) Main Dorm with several roommates ($20/night) Main Hotel style with 1 roommate ($36/night) Mountaineer Private Hotel Style ($82/night) Mountaineer Dorm Style with several roommates ($20/night) Mountaineer Hotel Style with 1 roommate ($41/night) Holt Private Room ($90/night) Holt Hotel with 1 Roommate ($45/night) Holt Hotel- I am 3rd person in room ($10/night) Holt Hotel- I am 4th person in room. ($10/night) OK Question Title * 10. I will be eating the following meals: Friday dinner $9.50 Saturday breakfast at dining hall $6.50 Saturday continental breakfast $5.00 Saturday Lunch $8.00 Saturday dinner $9.50 Sunday Breakfast at dining hall $6.50 Sunday continental breakfast $5.00 Sunday lunch $8.00 OK Question Title * 11. I will be attending the following interest group: Best Practices For Rebuilding a Women’s Group-Led by Jennifer Allen You are not alone-support for family and friends affected by the drug epidemic-Led by Professional/trained counselor Jewelry Making $10 fee Hand bells-Led by Lois Coffey Focusing on your own Spiritual Health-Led by Steven Smith Painting-Led by Rosetta Smith $10 fee OK Question Title * 12. I plan to sing in the choir? Yes No OK Question Title * 13. 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 OK DONE