Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Registration Form

Safe Harbor is hosting a women's retreat at Cedarmore in Bagdad, KY the weekend of April 28-29. Our guest speaker, Sandy Scrufari, will be teaching on One Anothering. The cost is $100 but we will offer some scholarship tickets if cost is a barrier. If you have any questions contact Elizabeth Lin, Dana Waldroup or visit the Safe Harbor website for more details.

Name

Address *

City, State Zip *

Phone *

Email *

Today's Date *

YYYY

Your birthdate *

YYYY

Are you a member of Safe Harbor? *

Yes

If not, what church do you currently attend?

I would like to room with

Food allergies, dietary restrictions or special needs

The cost of the retreat is $100 per woman for the full over night event.

Please make checks payable to Safe Harbor Baptist with "Women's Retreat" in the memo. Return this form and your payment to Elizabeth Lin or Dana Waldroup by April 2, 2023.

I will pay for my ticket by check.

I will pay for my ticket by check and I am willing to donate a scholarship ticket.

I will pay for my ticket online at SafeHarborBaptist.org.

I will pay for my ticket online and have donated funds for a scholarship ticket.

I would like to ask for a scholarship ticket.

If you are unable to attend the full retreat, please mark below what you are able to attend.

Friday Night Only ($20 for Dinner and Session #1 from 6:30-9:15pm )

Saturday Only ($30 for Breakfast, Session #2, Lunch, and Session #3 and #4 from 8:00-4:30)

Both Friday Night and Saturday without spending the night ($50)

Would you like to car pool to Cedarmore?

Yes

Clear selection

Are you willing to drive?

Yes

Maybe

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms