Women's Retreat Final Registration

Please complete and submit the following form.

August 27 - 30, 2015 (Thurs, Fri, Sat, Sun)
Stone House Retreat Center
Mebane, North Carolina

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

How will you be traveling? *

Will you need transportation to and from the airport or train/bus station? *

When do you arrive and depart? (details please) *

How many of your friends and/or family members will be in attendance? *

Would you like to be in the same cabin with them? *

Your Current Age Range *

Date of Birth *

Dietary Needs *

Are you a smoker? *

Do you have any allergies or restrictions? *

Do you have any gifts or talents that you would like to share? *

What are you most looking forward to at the retreat? *

Do you have any physical, mental or emotional challenges that we need to be aware of in order to better support you? *

Please give us any additional information that you would like to share. *

Submit