REGISTRATION FORM Foundry United Methodist Church

Annual Women’s Retreat 2017

Friday, February 17 – Sunday, February 19

Priest Field Pastoral Center, Kearneysville, WV

Please fill out this entire form and submit with your payment no later than Sunday, February 12, 2017

Name: ______

Preferred Phone: ______Alternate Phone: ______

Email: ______

Address: ______

LODGING (Total Retreat fee (room and meals)): I wish to reserve (please check one):

___ Dormitory - Multiple Occupancy (4+ per shared room) (per person) @ $199

___ Retreat Room - Double Occupancy (per person) @ $250

Name of preferred roommate (optional): ______

___ Retreat Room - Single Occupancy @ $300

_____ Please check if assistance with Retreat fee is requested. If so, $50 will be applied to dormitory or double room occupancy. If additional assistance is required please contact the Pastoral Staff. Assistance is provided on a “first come – first served” basis as funds are available.

TRAVEL: (check one):

(1)  ____ I will ride the Charter bus departing from (check one) ____ Foundry OR _____ Bethesda (Concord-St Andrews UMC). I will be leaving a car parked at Concord-St. Andrews (check one) _____ YES ____ NO

(2)  ____ I will drive my own vehicle to Priest Field Pastoral Center. I am leaving on ______(day/time). Can you offer other attendees a ride? ____ Yes ____ No If yes, how many? _____

(3)  ____ I need a ride. I can leave on ______(day/time) from ______(location)

Help Us Help You:

I require Vegetarian meals: If you desire vegetarian meals please circle “yes” and you will be served vegetarian meals throughout the entire weekend. The Center will only prepare vegetarian meals for those who pre-select. The Center is unable to prepare or provide other meal accommodations (e.g. gluten-free). / YES / NO
I require wheelchair or other accessibility accommodations, Please specify : ______/ YES / NO
Retreat Assistance: If requested, $50 will be deducted from the cost of a dormitory or double room. / YES / NO
Lodging/Meals: / Fee / Payment: / Payment in full is required to hold your reservation.
Pay by cash, check, (Foundry UMC) or credit card or online.
Dormitory (per person) / $199 / Lodging/Meals Fee / $
Retreat Room - Double (per person) / $250 / Saturday ONLY (lodging not included): / $
Retreat Room - Single / $300 / Subtotal
Saturday Attendance Only (incl meals) / $50 / Addtn’l Contribution to Assist Other Retreat Attendees and Retreat Costs / +$
TOTAL: