Kingdom Mandate Retreat Registration

First Name                    Last Name
    

Address                                                    City                               State                    Zip Code
                         

Pone Number                       Cell/Alternative Number              Email
                              

Please check/click the appropriate box below
Double Occupancy - $110.00 per person
             Roommate
Single Occupancy - $125.00 per person
Commuter Rate - $45.00 per person

All meals are included in the price.
Checks, cash, and all major credit cards are accepted.
Payment due at time of registration.

Please note any dietary or physical needs below:


Interested in a scholarship (click for yes)

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