Seneca Lake Baptist Assembly Registration Form

Ladies Fall Retreat, Sept 8-9, 2017

DEADLINE: Registration forms and a $30.00 deposit must bepostmarked on or before August 18, 2016. Please collect the balance due from each participant from your church prior to coming to the retreat and send only one person through the registration line with balance due.

ACCOMMODATIONS: Please indicate your choice of cabins or lodges. All prices listed below are per person and include the $30.00 deposit. (Deposit covers program fees and meals.) No provision is made for childcare at Seneca Lake Baptist Assembly. If you are the mother of a nursing baby, please call Mission Support and Mobilization at 614-601-1814 to make special arrangements (no babies in cabin/dorms, please).

 / EVERGREEN/CABINS($47/person)is the newest building on the facility and contains rooms that sleep 8 and rooms that sleep 16. The rooms have bunk beds and a common restroom and shower areas. (Please remember to bring your own bed linens or sleeping bag, pillow, towel, soap, shampoo, etc). Cabins will be used as overflow for Evergreen.
 / LODGES (Pricing Varies)Lakeside and Buckeye Lodge rooms are arranged hotel-style with two double beds and 1 full-sized sofa.
LAKESIDE/BUCKEYE
1 person/room……$72/person
2 people/room……$67/person
3 people/room……$62/person
4 or more/room…..$57/person / Please indicate first and second choice. Lodge rooms are granted on a first-come, first-served basis. If your lodging selections have already been filled, you will be assigned housing that is available. The receipt will indicate housing assignments.
 Lakeside Lodge  Buckeye Lodge
 / Handicap accessibility is needed. Please explain:

REGISTRATION PRICING:

In order for requests to be processed, a deposit fee of $30.00 per person must accompany registration. The balance due will be reflected on your return receipt and depends on your choice of lodging. After April 15,2016, the deposit is non-refundable; however it can be transferred to a substitute person for this event.

Total Number of Participants ______x $30.00 per person deposit = Deposit Amount Due: ______

IF STAYING IN LODGE: Number of Rooms Requested ______Number of People/Room ______

Please make checks payable to: State Convention of Baptists in Ohio (S.C.B.O.) and mail with this completed form to: Missions Support + Mobilization - State Convention of Baptists in Ohio–9000 Antares Ave. - Columbus, OH 43240 . This form must be mailed even if registering and paying online with credit card.

CONTACT INFORMATION:

Church Name / Phone
Pastor’s Name / Association
Contact Person / Phone / Email
Street Address* / Circle one: Contact’s address/Church address
City/State/Zip
Please indicate the name and phone number of a family member of one of the women participating as an emergency contact who may be reached after the group has departed for the event.
Emergency Contact / Phone

Address used above will receive receipt and other information for the retreat, so please mark if it is the church address or the contact’s address. Thank you!

Participants Names:

1. / 9.
2. / 10.
3. / 11.
4. / 12.
5. / 13.
6. / 14.
7. / 15.
8. / 16.