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Registration: Moms in Prayer retreat - 2017 (Jun 9, 2017 02:00 pm - Jun 11, 2017 02:00 pm)

The early registration fee is $140.00. It ends at 11 PM, May 25, 2017.
The late registration fee is $150.00. It starts at 11 PM, May 26 and ends at 11 PM, June 5th.

ATTENTION! Please do not fill out the form below if you are not ready to pay the fee using PayPal or your credit card.

Should you have any questions related to the registration, please call to Olga Drovorub (916) 397-1532 or Galina Bugriyev (916) 256-7363.

Terms and Conditions

Should you cancel the registration later, you should do it before June 5. After June 5, your registration fee is not refundable. To have your money back, you may find somebody who will come to the retreat in place of you.

USER INFORMATION
First Name:
Last Name:
Address:
City:
State:
Zip:
Email:
Confirm Email:
Phone:
Name of Church you attend:
Emergency Contact Name:
1
Emergency Contact Phone:
1
Medical insurance company name:
1
Health Problems:
No Problems
Heart Diseases
High blood pressure
Diabetes
Allergies
Other
1
Medications you usualy take and their doses:
1
Credit Card Holder's First Name:
1
Credit Card Holder's Last Name:
1
I agree with the registration terms and conditions, described above the registration form :
Yes
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