Spring Retreat 2019 - Chosen
Date:
Friday February 22, 2019 - Sunday February 24, 2019
Location
Warren W. Willis United Methodist Camp
4991 Picciola Rd, Fruitland Park, FL 3473
Name
*
Email
*
This address will receive a confirmation email
Home Phone
Cell Phone
*
Home Address
*
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Gender
*
Please select one option.
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Birth Date
*
Age
*
Expected Graduation
*
Please select one option.
2019
2020
2021
2022
2023
Grad Student
Which University or College do you attend?
*
Do you have any dietary restrictions? (allergies, etc.)
*
Emergency Contact Name
*
Relationship
*
Emergency Contact Cell Phone
*
Would you be able to drive to the retreat?
*
Please select one option.
Yes
No
Maybe
If yes, how many people could you take with you?
T-shirt size
*
Please select one option.
S
M
L
XL
Payment
95.00
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
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AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
Date:
Friday February 22, 2019 - Sunday February 24, 2019
Location
Warren W. Willis United Methodist Camp
4991 Picciola Rd, Fruitland Park, FL 3473
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