The Theme Within
JPD W & R Retreat 2010 Registration
Register early: space is limited!
Please PRINT FORM, FILL IN SPACES, MAIL W/CHECK to Anne (see below)
Name (please print)
____________________________________________________________________
Address_____________________________________________________________
Phone (home) _____________________(cell) ______________________________
Email _______________________________________________________________
Your Church _________________________________________________________
Roommate(s) name(s) (roommates must be listed on each other’s registration forms)
I can bring a drum/other musical instrument (just for fun!) _____________________
Please indicate here _____ if you require first-floor accommodation.
I am/am not (circle one) a vegetarian.
Special dietary circumstances? (Example: gluten or lactose intolerant; specific allergies)
_____________________________________________________________________
The Money Part: Retreat Rates and Opportunity
Rates for food and lodging are what the site charges
Commuter meals include Friday supper, Saturday lunch and supper, Sunday lunch
Resident $140 (includes two nights and 6 meals ) $_________
Commuter $105.00 (includes 4 meals) $_________
Registration: $60.00 (our costs) $___60____
My gift to help another woman attend $_________
GRAND TOTAL (add lines above)…………………… $_________
Please make your check payable to: Joseph Priestley District,
marking in the memo section “W & R Retreat”
*******Payment must be received by September 25th, 2010******
Mail to: Anne Slater, 2753 Morris Road, Ardmore, PA 19003
I will acknowledge receipt of your registration and check via email
