1. 2016 Women’s Ministries Retreat Eastern Division September 8-10 Western Division September 15-17 PLEASE ONLY FILL OUT ONE FORM PER CHURCH – INCLUDE NAMES ON SECOND PAGE Church ______________________________________________ Church City ________________________Church Phone ________________ Section________________ **PLEASE FILL OUT THE CONTACT INFORMATION SO WE MAY CONFIRM YOUR REGISTRATION** Contact Person ___________________________________ Daytime Phone (____)________________ Home Address _______________________________ City, State, Zip ____________________________ E-mail Address ___________________________________________________Confirmation will be emailed Hotel Bedding & Towels WILL be provided 4 or 5 per room Cost $130.00 (per person) After August 1 st Add $10.00 Motel (On the Hill) Bedding & Towels WILL be provided Upper room (2 beds) 4 per room $110.00 per person Upper room (2 beds) 3 per room $120.00 per person Upper room (2 beds) 2 per room $130.00 per person Lower room (1 bed) 2 per room $110.00 per person Lower room (1 bed) 1 per room $120.00 per person After August 1 st Add $10.00 Dorm Bedding & Towels will NOT be provided (The beds are twin size) Cost: $110.00 per person After August 1 st Add $10.00 Hotel - # of Ladies _______ [ ]4 per room [ ]5per room Amt Paid $__________ Motel - # of Ladies _______ [ ]4 upper [ ]3 upper [ ]2 upper [ ]2 lower [ ]1 lower Amt Paid $__________ Dorm - # of Ladies _______ Amt Paid $ ______________ Registration Only - # of Ladies __________ Amt Paid $__________ After August 1 st _______ X $10 Amt Paid $__________ Craft Tables _____table/s X $10 Amt Paid $__________ TOTAL NUMBER OF LADIES REGISTERED ON THIS FORM _________ TOTAL PD $__________ Check Retreat Attending Registration Only $10 Meals & Lodging Not included Office Use Only Received:__________________________ Payment:__________________________ Housing:___________________________ $25 non-refunded up to Aug 1 st. After that date there are NO refunds. Sorry no exceptions (All monies are transferable within your own group)

2. Ladies Attending List first and last names of ladies and how you want them housed HOTEL 1.__________________ 2.__________________ 3__________________ 4.__________________ 5. _________________ 1.__________________ 2.__________________ 3__________________ 4.__________________ 5. _________________ 1.__________________ 2.__________________ 3__________________ 4.__________________ 5. _________________ 1.__________________ 2.__________________ 3__________________ 4.__________________ 5. _________________ MOTEL 1.__________________ 2.__________________ 3__________________ 4.__________________ 1.__________________ 2.__________________ 3.__________________ 4.__________________ DORM 1.__________________ 2.__________________ 3__________________ 4.__________________ 5.__________________ 6.__________________ 7.__________________ 8.__________________ 9.__________________ 10._________________ 11._________________ 12._________________ 13._________________ 14._________________ 16._________________ 17._________________ 18._________________ 19._________________ 20._________________ 21._________________ 22._________________ 23._________________ 24._________________ 25._________________ 26._________________ 27._________________ 28._________________ 29._________________ 30._________________ 31._________________ 32._________________ Return forms to: To pay by CC please call 417-881-1316 Women’s Ministries Dept 528 W Battlefield Springfield, MO 65807 * You may also use separate sheet to indicate housing